PD patients who maintain proper nutrition (eating enough calories and protein daily) tend to feel better and live longer. For each kilogram (2.2 pounds) of body weight, daily intake of 35-45 calories including 1.2 grams of protein are recommended for proper nutrition of PD patients. While it is sometimes difficult to eat enough calories and protein, research has shown malnourished patients are more likely to die earlier, spend more time in the hospital, and even have more problems with their PD access than well nourished patients. Proper nutrition is as important as adequate dialysis is to the quality and length of a patient’s life. One measure of nutritional status is the value of serum albumin concentration, which is normally included in monthly blood tests. PD patients who are well dialyzed and eating satisfactorily should have a serum albumin concentration in the normal range for the laboratory testing serum albumin: certainly above 3.3 g/dl, preferably 3.8-4.0 g/dl.

There are many reasons why serum albumin varies and may be below normal:
1. Protein intake in the diet is inadequate
2. Some protein is normally lost in drained dialysate
3. Some patients lose large amounts of protein in the urine or have gastrointestinal diseases that interfere with proper absorption of protein
4. Complicating illness such as infection, an episode of heart failure or a surgical procedure, uncontrolled diabetes, as well as the flare-up of an autoimmune disorder interferes with albumin synthesis
5. Metabolic acidosis can interfere with appetite, cause muscle wasting and decreased albumin synthesis
6. Protein and albumin losses in drained dialysate increase with peritonitis
7. Under-dialyzed patients may have malnutrition - albumin levels that are below normal due to loss of appetite, poor protein and calorie intake.

In addition, if a patient is increasing his/her dialysis dose, he/she may eventually have a bigger appetite and need more protein.  Patients who are maintaining proper nutrition and being well dialyzed should not be losing weight or suffering from a poor appetite. If a patient is well dialyzed and are still losing weight then another cause should be sought. A patient with low albumin levels needs to discuss this and other symptoms with his/her doctor or dietitian to determine the cause and what must be done to increase the serum albumin and maintain proper nutrition.

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