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Protein loss and glucose absorption in children with AKI treated with peritoneal dialysis
Peter Nourse1, Mignon McCulloch1, Ashton Coetzee1
1Division of Pediatric Nephrology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
Insights
Children undergoing acute peritoneal dialysis (PD) experience significant protein loss and glucose absorption. Continuous flow PD showed higher protein losses than conventional PD, impacting nutritional management in acute kidney injury (AKI).
Area of Science:
- Pediatric Nephrology
- Renal Nutrition
- Dialysis Therapy
Background:
- Accurate assessment of protein loss and glucose absorption is crucial for nutritional management in children with acute kidney injury (AKI) undergoing peritoneal dialysis (PD).
- Limited data exist regarding these parameters in pediatric AKI patients on PD.
- This study addresses this gap through a secondary analysis of existing trial data.
Purpose of the Study:
- To quantify and compare glucose absorption and protein (albumin) loss into dialysate in children with AKI on conventional PD versus continuous flow PD (CFPD).
- To explore correlations between albumin loss, glucose absorption, and other patient/dialysis factors.
Main Methods:
- Secondary analysis of a crossover randomized controlled trial involving 15 children with AKI.
- Comparison of dialysate albumin loss and glucose absorption between conventional PD and CFPD.
- Analysis of correlations between albumin loss, glucose absorption, ultrafiltration, and patient/dialysis variables.
Main Results:
- Mean daily albumin loss was 0.3 g/kg in conventional PD and 0.56 g/kg in CFPD.
- Mean daily glucose absorption was 4.67 g/kg in conventional PD and 3.85 g/kg in CFPD.
- A moderate correlation between ultrafiltration and albumin loss was observed during CFPD (R=0.61, p=0.02). No significant differences in glucose absorption or albumin loss were found between PD modalities, though the study was not powered for this.
Conclusions:
- Protein losses and glucose absorption in children with AKI on PD are substantial and require consideration in nutritional prescriptions.
- Protein losses were notably higher with CFPD compared to conventional PD.
- Findings underscore the importance of tailored nutritional support for pediatric AKI patients on dialysis.
Background:
Protein loss and glucose absorption in children on acute peritoneal dialysis (PD) is important to inform dietary prescription, yet data are lacking in this regard. This study was a secondary analysis of a previously published crossover randomised controlled trial, aiming to describe glucose uptake and protein loss into dialysate among children with acute kidney injury (AKI) receiving PD.
Methods:
This secondary analysis described and compared dialysate albumin loss and glucose absorption in 15 children with AKI receiving PD or continuous flow peritoneal dialysis (CFPD). In addition, correlations between albumin loss, glucose absorption and other patient and dialysis factors were analysed.
Results:
Median (range) age and weight of participants were 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg, respectively. Patients received approximately 8 h of dialysis on each modality; however, results were extrapolated and expressed per day. The mean ± SD albumin loss on conventional PD and CFPD was 0.3 ± 0.19 g/kg/day and 0.56 ± 0.5 g/kg/day, respectively, and the mean ± SD glucose absorption was 4.67 ± 2.87 g/kg/day and 3.85 ±4.1 g/kg/day, respectively. There was a moderate correlation between ultrafiltration and albumin loss during CFPD only (Pearson's R = 0.61; p = 0.02). There were no significant differences between PD and CFPD for either glucose absorption or albumin loss; however, the study was not powered for this outcome.
Conclusions:
Protein losses and glucose absorption in children on PD with AKI are significant and should be considered when prescribing nutritional content. Protein losses on CFPD were twice as high as on conventional PD.
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