Body composition in children on peritoneal dialysis

Area of Science:

• Pediatric Nephrology
• Nutritional Science
• Radiology

Background:

• Peritoneal dialysis (PD) can impact bone mineral content (BMC), bone mineral density (BMD), fat-free mass (FFM), and fat body mass (FBM).
• Assessing body composition and its relationship with nutritional and clinical parameters is crucial for PD patients.

Purpose of the Study:

• To evaluate body composition in children undergoing PD using DEXA.
• To determine the relationship between body composition, nutritional status, dialytic parameters, and biochemical data in pediatric PD patients.

Main Methods:

• Utilized DEXA to assess BMC, BMD, FFM, and FBM in 20 pediatric PD patients over 6 months.
• Collected data on anthropometry, dietary intake (protein, energy), nitrogen balance (NB), Kt/V, peritoneal equilibrium test (PET), and serum biochemistry.
• Prescribed energy intake and protein intake according to established guidelines (USRDAs, DOQI).

Main Results:

• Significant increases in BMD (p < 0.05) and BMC (p < 0.01) were observed over 6 months.
• BMD Z scores improved significantly in patients older than 4 years (from -0.69 to -0.35).
• High daily protein intake (DPI) showed negative correlations with BMD, BMC, and FFM (p < 0.05).
• Negative correlations were found between NB and BMD, FBM, and FFM (p < 0.05).
• Dialysate-to-plasma creatinine ratio from PET negatively correlated with BMD and FFM (p < 0.05).

Conclusions:

• Positive nitrogen balance and controlled Kt/V are associated with improved bone mineralization in pediatric PD patients.
• High protein intake may adversely affect acid-base status, bone mineralization, and FFM in this population.
• DEXA is a valuable tool for monitoring body composition changes in children on PD.