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Is growth a valid outcome measure of dialysis clearance in children undergoing peritoneal dialysis?
V Chadha1, D L Blowey, B A Warady
1Section of Nephrology, Children's Mercy Hospital, University of Missouri, Kansas City 64108, USA.
Insights
Growth in children with end-stage renal disease on peritoneal dialysis is linked to solute clearance. Residual renal function significantly impacts growth outcomes, suggesting it plays a crucial role in PD adequacy.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Growth and Development
Background:
- Peritoneal dialysis (PD) is a treatment for end-stage renal disease (ESRD) in children.
- Assessing PD adequacy is crucial for optimizing patient outcomes.
- Growth is a key indicator of health and treatment effectiveness in pediatric ESRD patients.
Purpose of the Study:
- To evaluate growth as a clinical outcome measure for peritoneal dialysis adequacy in children with ESRD.
- To investigate the relationship between solute clearance, residual renal function, and growth in pediatric PD patients.
Main Methods:
- Retrospective single-center study of 24 pediatric patients with ESRD on PD for at least 1 year.
- Analysis of growth parameters (height standard deviation score - SDS) and dialysis adequacy markers (creatinine clearance - C(Cr), Kt/V(urea)).
- Comparison of growth and clearance metrics between patients with and without residual renal function (RRF).
Main Results:
- Catch-up growth (positive delta height SDS) was observed in 37% of patients, predominantly those with RRF (78%).
- Patients with RRF showed improved height SDS compared to those without RRF, who experienced worsening height SDS.
- While Kt/V(urea) was similar, native creatinine clearance was significantly higher in patients with RRF and correlated with growth.
Conclusions:
- Preliminary data suggest a correlation between solute clearance and growth in pediatric PD patients.
- Residual renal function significantly influences growth outcomes, highlighting its importance in PD adequacy.
- The findings may challenge the assumed equivalence of PD and native clearance in children with ESRD.
Objective:
Our study evaluated growth as a clinical outcome measure of peritoneal dialysis (PD) adequacy in children with end-stage renal disease (ESRD).
Design:
This retrospective single-center study was carried out in our tertiary-care medical center.
Patients:
The study enrolled 24 patients who initiated dialysis after January 1, 1995, and who had been on dialysis for a minimum of 1 year.
Results:
The weekly mean total [PD + residual renal function (RRF)] creatinine clearance (C(Cr)) and Kt/V(urea) were 70.3 +/- 18 L per 1.73 m2 and 3.45 +/- 0.73, respectively. Of the 24 patients, 12 (50%) were anuric. The mean height standard deviation score (SDS) changed to -1.78 at the end of 1 year from -1.58 at baseline. Catch-up growth (positive delta height SDS) was observed in 9 patients (37%), 7 of whom (78%) had residual renal function (RRF). In contrast, only 5 of 15 patients (33%) with a negative deltaSDS for height had RRF (p < 0.025). The mean height SDS in patients with RRF improved to -1.64 from -1.78; in patients without RRF, it worsened to -1.90 from -1.37 (p = 0.01). While the weekly total Kt/V(urea) in patients with RRF (3.53) was similar to that in patients without RRF (3.37, p = 0.6), only the native Kt/V(urea) had a significant (but weak) positive correlation with delta height SDS (r2 = 0.17, p = 0.04). In contrast, the total weekly C(Cr) was significantly higher (p = 0.001) in patients with RRF (81.1 L/1.73 m2) as compared with those without RRF (59.5 L/1.73 m2). However, only the native C(Cr)--and not the dialysis C(Cr)--had a significant (but weak) positive correlation with delta height SDS (r2 = 0.17, p = 0.04).
Conclusions:
These preliminary data provide evidence for a correlation between solute clearance and growth, with RRF exerting a significant influence on that outcome. The Kt/V(urea) data also appear to contradict the presumed equivalence of PD and native clearance in children with ESRD.
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