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Growth in very young children undergoing chronic peritoneal dialysis
Lesley Rees1, Marta Azocar, Dagmara Borzych
1Renal Office, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, United Kingdom. Reesl@gosh.nhs.uk
Insights
Growth and nutrition in young children with chronic kidney disease vary by region. Gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy are linked to better linear growth in these patients.
Area of Science:
- Pediatrics
- Nephrology
- Nutrition Science
Background:
- Chronic kidney disease (CKD) in very young children often leads to poor nutrition and short stature.
- Supplemental feeding methods like nasogastric (NG) tubes or gastrostomy may impact growth, but their effectiveness is not fully understood.
Purpose of the Study:
- To analyze the impact of different feeding strategies and medical interventions on growth and nutritional status in infants and toddlers with CKD undergoing chronic peritoneal dialysis.
- To investigate regional variations in growth and nutritional outcomes.
Main Methods:
- Analysis of data from 153 children (<24 months at dialysis initiation) across 18 countries.
- Categorization of feeding methods: demand feeding, NG tube, and gastrostomy.
- Assessment of body mass index (BMI) and body length changes over time.
- Statistical analysis to identify associations between feeding methods, interventions (biocompatible dialysate, growth hormone), and growth outcomes, considering regional factors.
Main Results:
- Body mass index (BMI) decreased with demand feeding and increased with NG tube or gastrostomy feeding.
- Significant regional variations in BMI were observed, with North American children showing higher obesity rates and Turkish children exhibiting malnutrition.
- Gastrostomy feeding and growth hormone therapy were independently associated with improved linear growth, even after adjusting for baseline length and regional factors.
- Biocompatible peritoneal dialysate also correlated with better length outcomes.
Conclusions:
- Growth and nutritional status in very young children with CKD on chronic peritoneal dialysis exhibit significant regional disparities.
- Gastrostomy feeding, use of biocompatible dialysis fluid, and growth hormone therapy are associated with improved linear growth in this vulnerable population.
Abstract:
Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at <24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy. Standardized body mass index (BMI) uniformly decreased during periods of demand feeding and increased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation: 26% of North American children were obese and 50% of Turkish children were malnourished at last observation (P < 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P < 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal dialysate and administration of growth hormone independently associated with improved length, even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth.
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