Abstract: 【Abstract】Objective To analyze the effects of optimized dietary protein on nutrition status and related parameters in peritoneal dialysis (PD) patients and to explore the independent factors for high quality protein intake. Methods A retrospective analysis was performed on patients with stable PD for more than one month. Patients were divided into optimized group (n=51) for those with high quality protein intake rate ≥50% and non-optimized group (n=41) for those with high quality protein intake rate ＜50%. Education mode, food diary in 3 days, dietary protein intake (DPI), calorie intake, ratio of egg white protein in total protein intake, serum albumin, hemoglobin, phosphorus, parathyroid hormone and fibroblast growth factor 23 (FGF23) were compared between the two groups. Urea clearance index (Kt/V), total creatinine clearance (Ccr), residual renal function (RRF) and normalized protein catabolic rate (nPCR) were calculated. Results Dietary protein intake (t=3.097, P=0.003), high quality protein intake (t=6.321, P＜0.001), percentage of egg white protein in-take (χ²=80.126, P=0.012), serum albumin (39.54 ± 4.09 vs. 36.08 ± 4.71g/L, t=3.769, P＜0.001), Kt/V (t= 2.500, P=0.014), Ccr (t=2.176, P=0.032), RRF (z=4.093, P=0.043) and ratio of education with intensified We-Chat management (76.47% vs. 26.83%, χ²=22.574, P＜0.001) were higher in optimized group than in non-optimized group. Serum phosphorus (t=0.646, P=0.519), parathyroid hormone and FGF23 (z=1.701, P=0.192) had no statistical differences between the two groups. Multiple regression revealed that high quality protein intake (P=0.001), percentage of egg white protein intake (P=0.033), nPCR (P=0.009), dialysis age (P=0.002), serum albumin (P=0.031) and WeChat management (P＜0.001) were the independent factors for high-quality protein intake rate. Conclusion The conventional education contents of higher ratio of egg protein intake for lower phosphorus intake, communication using WeChart and high quality protein intake ≥50% are useful for the increase of serum albumin and dialysis adequacy, protection of RRF and lower risk of hyperphosphatemia.
The independent factors for higher quality protein intake can be used as references for the optimization of dietary protein intake in PD patients.

Key words: optimizing dietary protein intake, Peritoneal dialysis, egg white, protein-energy wasting, hyperphosphatemia