Protein and energy requirements in children receiving chronic hemodialysis

Protein and energy requirements were evaluated in 15 children with chronic renal failure. The children were ambulatory and stable, being maintained on hemodialysis and a well-tolerated diet regime. The goals of the study were (1) to approximate the dietary protein and energy levels needed to produce a positive protein balance and (2) to estimate the effect of diet on dialysis requirements. In positive balance periods (18 of 24 periods), the protein intake varied between 0.2 and 0.5 g/cm/day and the energy intake varied between 6.4 and 21.2 kcal/cm/day. A linear relationship existed between the PCR and the protein intake for positive as well as negative protein balance periods. PCR--thus urea generation--was uniformly lower for children in positive balance. Results suggest that a positive balance can be achieved at a protein intake of 0.3 g/cm of statural height and at an energy intake of 10 kcal/cm without an increase in dialysis requirements.