Assessment of relationship between nutrition and growth in pediatric hemodialysis patients

Nutrition and growth are important outcome indicators in pediatric (Ped) hemodialysis (HD) patients. We hypothesized that there is a discrepancy among traditional measures of nutrition, and that adequate nutrition may not reliably predict growth.

We assessed longitudinal nutrition and growth parameters in 14 Ped HD patients over 1 year. Their age at the end of the study was 15.9 +/- 0.6 years, SEM.

For the entire cohort over 1 year, serum albumin (Alb) was 4.3 +/- 0.0 g/dL, and the normalized protein catabolic rate (nPCR) was 1.0 +/- 0.0 (correlation, 0.33; P < .0001). The relationship between Alb and nPCR was significant in only 4/14 (29%). The mean standard deviation and variance were higher for Alb (0.27 +/- 0.03) compared with nPCR (0.18 +/- 0.02). The body mass index percentile (BMI%) was 35.5 +/- 2.9, the percent ideal body weight (%IBW) was 96.2 +/- 1.5, the height-SDS, or standard deviation score (Ht-SDS) was -1.30 +/- 0.11, and the percent weight change (PWC) was +4.9% +/- 1.9%. The highest incidence of reaching our targets for growth was seen for the BMI% (64% of patients) and PWC (79% of patients). The target for Ht-SDS was attained in only 21%. There was a significant negative relationship between Alb and nPCR with BMI%, %IBW, and Ht-SDS, and a significant positive relationship between Alb and nPCR with PWC.

We conclude that the relationship between Alb and nPCR is weak in individual patients, and that adequate nutrition does not reliably predict growth in Ped HD patients.