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Kt/V or Bicarbonate: What Is More Important for Growth in Pediatric Peritoneal Dialysis Patients?
Lucimary de Castro Sylvestre1,2, Rejane de Paula Bernardes3, Débora Stremel Ribeiro4
1Division of Pediatric Nephrology, Department of Pediatrics, Hospital Pequeno Príncipe, Curitiba, Brazil.
Insights
Pediatric chronic kidney disease patients on peritoneal dialysis (PD) did not show improved growth with increased dialysis adequacy. Normalizing bicarbonate levels may be key to improving height in children undergoing PD.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Growth retardation is a significant challenge for children with chronic kidney disease (CKD).
- The impact of enhanced peritoneal dialysis (PD) on growth in pediatric CKD patients remains unclear.
Purpose of the Study:
- To investigate the relationship between peritoneal dialysis adequacy parameters and growth outcomes in children.
- To determine if increased dialysis can augment growth in pediatric patients with CKD.
Main Methods:
- A longitudinal study of 53 children (27 males) on PD, assessing growth using height standard deviation scores (SDS) and growth velocity z-scores.
- Two adequacy tests were performed at 9-month intervals, comparing intraperitoneal pressure and KDOQI guidelines to growth measures.
- Univariate and multivariate analyses were used to identify correlations.
Main Results:
- The median total weekly Kt/V and creatinine clearance were higher than in previous pediatric studies.
- No significant correlation was found between height SDS or growth velocity z-scores and dialysis adequacy parameters like Kt/V or creatinine clearance.
- Growth improvement (delta height SDS) was associated with age, bicarbonate levels, and intraperitoneal pressure.
Conclusions:
- Increased peritoneal dialysis adequacy (Kt/V, creatinine clearance) did not directly improve growth in pediatric CKD patients.
- Normalization of serum bicarbonate concentrations is highlighted as a crucial factor for improving height z-scores in these patients.
Introduction:
Growth retardation is a common problem in pediatric patients with chronic kidney disease. It is unknown if the growth of children on peritoneal dialysis (PD) can be augmented by more dialysis.
Methods:
We studied the effect of various peritoneal adequacy parameters on delta height standard deviation scores (SDSs) and growth velocity z-scores in 53 children (27 males) on PD, who underwent 2 longitudinal adequacy tests at 9-month intervals. None of the patients were on growth hormone. Intraperitoneal pressure and standard KDOQI guidelines were compared to the outcome measures delta height SDS and height velocity z-scores, using univariate and multivariate tests.
Results:
At the time of the second PD adequacy test, their mean age was 9.2 ± 5.3 years; mean fill volume was 961 ± 254 mL/m2; and median total infused dialysate volume was 5.26 L/m2/day (range 2.03-15.32 L). The median total weekly Kt/V was 3.79 (range 0.9-9.5), and the median total creatinine clearance was 56.6 (range 7.6-133.48) L/week, higher than previous pediatric studies. The delta height SDS was a median of -0.12 (range -2 to +3.95)/year. The mean height velocity z-score was -1.6 ± 4.0. The only relationships discovered were between the delta height SDS and age, bicarbonate, and intraperitoneal pressure, but not for Kt/V or creatinine clearance.
Conclusion:
Our findings highlight the importance of normalization of bicarbonate concentrations to improve height z-score.
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