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Published on: October 2, 2020
Nutrition aspects in children receiving maintenance hemodialysis: impact on outcome
Poyyapakkam R Srivaths1, Craig Wong, Stuart L Goldstein
1Department of Pediatrics, Baylor College of Medicine and Renal Services, Texas Children's Hospital, Houston, TX 77030, USA. prsrivat@TexasChildrensHospital.org
Insights
Malnutrition significantly increases mortality risk in children with end-stage renal disease (ESRD). Normalized protein catabolic rate (nPCR) is a key indicator, and intradialytic parenteral nutrition (IDPN) offers a vital supplementation route.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Renal Medicine
Background:
- Children with end-stage renal disease (ESRD) face significantly higher mortality rates (30x) than healthy peers.
- Undernutrition, indicated by low BMI and height SDS, is linked to increased mortality in pediatric ESRD.
- Traditional nutritional markers like albumin may be unreliable in children on maintenance hemodialysis.
Purpose of the Study:
- To review the current understanding of malnutrition in children undergoing maintenance hemodialysis.
- To highlight the significance of normalized protein catabolic rate (nPCR) as a nutritional marker.
- To discuss the role and outcomes of intradialytic parenteral nutrition (IDPN) in this patient population.
Main Methods:
- This article presents a state-of-the-art review of existing literature.
- Focuses on nutritional assessment, specifically nPCR.
- Examines the application and impact of IDPN in malnourished pediatric hemodialysis patients.
Main Results:
- Normalized protein catabolic rate (nPCR) is identified as a superior marker for nutritional status in pediatric hemodialysis.
- Intradialytic parenteral nutrition (IDPN) is an emerging strategy for nutritional support in malnourished children on maintenance hemodialysis.
- The review synthesizes data on outcomes related to nutritional status, nPCR, and IDPN.
Conclusions:
- Effective nutritional management is critical for improving outcomes in children with ESRD.
- nPCR provides a more accurate assessment of nutritional status than traditional markers.
- IDPN represents a valuable therapeutic option for addressing malnutrition in this vulnerable group.
Abstract:
Children with end-stage renal disease (ESRD) have rates of mortality estimated to be 30-times higher than expected for age compared with those of healthy children. Physical manifestations of under-nutrition, such as body mass index (BMI) and low height standard deviation score (SDS), have been associated with increased risk of mortality. Traditional measures, such as height, weight and serum albumin concentration, may not be accurate indicators to assess the nutritional status of children receiving maintenance hemodialysis. Normalized protein catabolic rate (nPCR) has emerged as a better marker of nutritional status of such children. Meeting the special nutritional needs of these children often requires nutritional supplementation, by either the enteral or the parenteral route. Recently, in children receiving maintenance hemodialysis who are malnourished, intradialytic parenteral nutrition (IDPN) has been utilized as a means to provide additional protein and calories. This article is a state-of-the-art review of malnutrition in children receiving maintenance hemodialysis, with special focus on outcome, nPCR and IDPN.
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