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Prevalence of protein malnutrition in children maintained on peritoneal dialysis
Andrew S Brem1, Cynthia Lambert, Connie Hill
1Division of Pediatric Nephrology, Rhode Island Hospital APC-942, 593 Eddy Street, Providence 02903, USA. Andrew_Brem@Brown.edu
Insights
Children on peritoneal dialysis (PD) face a higher risk of low serum albumin, a marker of malnutrition, compared to those on hemodialysis (HD) or adults. Current protein intake recommendations may be insufficient for pediatric PD patients.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Renal Disease Research
Background:
- Establishing evidence-based treatment guidelines for pediatric end-stage renal disease (ESRD) is challenging due to a lack of outcome measures.
- Serum albumin is a recognized indicator of nutritional status and mortality risk in ESRD patients.
- The nutritional status of children undergoing dialysis, particularly peritoneal dialysis (PD), requires further investigation.
Purpose of the Study:
- To investigate the prevalence of low serum albumin in pediatric patients on PD.
- To compare the prevalence of low serum albumin in children on PD versus those on hemodialysis (HD) and adult PD patients.
- To assess if current protein intake recommendations are adequate for pediatric PD patients.
Main Methods:
- Prospective data collection over 24 months (1999-2000) from children (1-18 years) on PD or HD in the New England area.
- Analysis of 64 observations from 39 children on PD and 47 observations from 32 children on HD.
- Comparison of low serum albumin prevalence (<2.9 g/dl) with historical data from adult ESRD patients on PD and HD.
- Estimation of dietary protein intake using calculated protein catabolic rate (PCR).
Main Results:
- The prevalence of low serum albumin in children on PD was 35.9%, significantly higher than in adult PD patients (19.5%, P<0.004).
- No children on HD exhibited low serum albumin, compared to 5.5% in adult HD patients.
- Mean protein catabolic rate (PCR) was similar in pediatric PD and HD patients (1.1 g/kg/day), suggesting inadequate intake for PD patients.
Conclusions:
- Children on PD are at a significantly higher risk of protein malnutrition compared to children on HD and adult dialysis patients.
- The standard protein intake of approximately 1 g/kg/day may be insufficient for maintaining adequate nutrition in children on PD.
- Further research and revised nutritional guidelines are needed for pediatric PD patients to improve outcomes.
Abstract:
A paucity of outcome measures exist for children, making evidence-based treatment guidelines difficult to establish. Serum albumin has been identified as a surrogate marker for nutritional status and morbidity/mortality in patients with end-stage renal disease (ESRD). We hypothesized that the prevalence of low serum albumin (<2.9 g/dl) in children on peritoneal dialysis (PD) may be greater, making this population at risk. Patient data were collected prospectively over 24 months (1999-2000) from all children (1-18 years) maintained on either hemodialysis (HD) or PD within the six-state New England area; 64 observations were made on 39 children on PD over the 2-year period. The mean age was 11.7+/-4.7 years (mean+/-SD). The prevalence of low serum albumin in children was 35.9% (23/64 observations) compared with 19.5% (712/3,719 observations) in adult Network ESRD patients on PD ( P<0.004). None of the 32 children (47 observations) maintained on HD exhibited low serum albumin during the data collection period. The prevalence of low serum albumin in adult HD patients was 5.5%. Dietary protein intake was estimated from a calculated protein catabolic rate (PCR). PCRs in children treated with both PD and HD were similar, averaging 1.1+/-0.4 g/kg per day (mean+/-SD). Thus, children maintained on PD are at greater risk of protein malnutrition compared with peers treated with HD and adults on PD or HD. A PCR of approximately 1 g/kg per day may not be adequate to maintain nutrition.