Hemodialysis-Related Protein and Amino Acid Losses in Children

Kidney failure in children causes systemic complications and protein-energy malnutrition due to losses of amino acids, dipeptides, and proteins during dialysis, which may impair growth. This study measured protein and amino acid losses during hemodialysis in children and examined clinical and dialysis-related factors associated with these losses.

A total of 11 children on chronic hemodialysis at Konya City Hospital were prospectively studied. Demographics, nutritional intake, dialysis parameters, and anthropometric measurements were recorded. Blood and dialysate effluent samples were analyzed for total protein, albumin, and 31 individual amino acids. Losses were grouped as essential amino acids, nonessential amino acids, and branched-chain amino acids. Associations between losses and clinical variables were assessed.

The median age was 10.2 years (IQR: 4.2); the median height standard deviation score was -2.96 (IQR: 5.47), and the median weight standard deviation score was -2.42 (IQR: 2.92). All patients showed measurable albumin and amino acid losses in dialysate. Median albumin loss was 1.0 g per 120 L (IQR: 1.10). Higher dietary protein intake, older age, and higher blood flow rate were associated with greater effluent essential and branched-chain amino acid levels (p < 0.05). Greater protein and amino acid losses showed a trend toward association with lower height and weight standard deviation scores, though not consistently statistically significant. Higher Kt/V and urea reduction ratios were associated with larger reductions in plasma amino acid concentrations.

Children on hemodialysis experience measurable albumin and amino acid losses. These findings suggest that such losses may contribute to protein-energy wasting and impaired growth, highlighting the potential importance of individualized dialysis prescriptions and nutritional strategies in pediatric patients.