Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance

Area of Science:

• Pediatric Nephrology
• Growth and Development
• Renal Replacement Therapy

Background:

• Children on maintenance hemodialysis typically exhibit poor growth, losing 0.4-0.8 SD in height annually.
• Conventional dialysis regimens and nutritional support are often insufficient to optimize growth in this population.

Purpose of the Study:

• To evaluate the efficacy of an intensive hemodialysis regimen combined with enhanced nutritional support on growth in children.
• To determine if exceeding conventional dialysis urea clearances and optimizing nutrient intake can normalize growth velocity.

Main Methods:

• A cohort of 12 prepubertal/early pubertal children (7 months-14 years) on maintenance hemodialysis was monitored.
• An intensive program involved closely monitored energy (90.6% recommended) and protein (155.9% recommended) intake.
• Dialysis urea clearances exceeded recommendations (mean 2.00 L/min normalized, 84.7% urea reduction ratio, 14.8 h/wk dialysis duration).

Main Results:

• Children experienced a mean height SD score improvement of +0.31 SD/year (or +0.32 SD/year excluding growth hormone treatment).
• Normal growth velocity and pubertal growth spurts were observed.
• Adequate growth was achieved without the development of overt obesity.

Conclusions:

• Combining intensified hemodialysis with adequate nutritional support can promote normal growth in children with end-stage renal disease.
• This strategy effectively addresses the historically poor growth outcomes associated with maintenance hemodialysis.
• Optimizing dialysis adequacy and nutritional intake is crucial for achieving catch-up growth and normal development.