Causes of Poor Appetite in Patients on Peritoneal Dialysis

Anorexia is common in patients with chronic kidney disease and is a main contributor to the high prevalence of protein-energy wasting in them. The peritoneal dialysis (PD) procedure may further impair appetite by causing abdominal discomfort and also through the absorption of the osmotic agent and other factors. An increased peritoneal solute transport rate has been linked to protein-energy wasting and also to the malnutrition, inflammation, and atherosclerosis syndrome, which has been associated to poor appetite and plays a role in most premature deaths in these patients. The pathogenesis of these associations is unclear. In this review, we discuss the effect of PD, in particular, PD solutions, inflammation, and increased peritoneal solute transport rate, on appetite. We also describe strategies to increase appetite in PD patients.