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Metabolic aspects of continuous ambulatory peritoneal dialysis with reference to energy-protein input and growth
Insights
Continuous ambulatory peritoneal dialysis (CAPD) in children with end-stage renal failure improves glucose metabolism and nitrogen balance. This anabolic therapy positively impacts growth factors, offering a promising approach for managing growth retardation.
Area of Science:
- Pediatric Nephrology
- Metabolic Studies
- Renal Replacement Therapy
Background:
- Children with end-stage renal failure often experience growth retardation and metabolic disturbances.
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment option for these patients.
Purpose of the Study:
- To evaluate the effects of CAPD on glucose metabolism and nitrogen balance in children.
- To assess CAPD's impact on growth parameters in pediatric patients with end-stage renal failure.
Main Methods:
- Assessed glucose utilization from dialysate and insulin response in 5 children undergoing CAPD.
- Monitored nitrogen balance on controlled diets over 12 months.
- Evaluated glucose tolerance and growth parameters.
Main Results:
- Significant glucose utilization from dialysate (up to 140 g/day) and increased insulin secretion observed.
- Improved glucose tolerance and insulin response after 6 months of CAPD.
- Positive nitrogen balance indicating an anabolic effect; variable growth outcomes noted.
Conclusions:
- CAPD demonstrates anabolic properties beneficial for children with end-stage renal failure.
- The therapy positively influences factors related to growth retardation.
- CAPD presents a valuable tool for future research in pediatric renal failure management.
Abstract:
Glucose utilization from the dialysate of up to 140 g/day was found during CAPD therapy in 5 children on short and long term studies. The energy input via the dialysate was associated with increased insulin secretion as indicated by the daily insulin response calculated from analyzing the area under the insulin curve during 5 daily exchanges of dialysate. After 6 months glucose tolerance was normal with normal values for early and late insulin response as well as for glucose disappearance rate during an intravenous glucose tolerance test. Nitrogen balance on free diets (energy input 100% RDA and protein input 133% RDA) showed that CAPD is an anabolic technique since the balance was positive when measured during 42 days out of 12 months in each child. Growth was normal in one boy and in addition a girl reached her final height; it was unsatisfactory in the other children. It is concluded that CAPD is an anabolic technique which favourably affects many factors associated with growth retardation in children with end stage renal failure and therefore it represents an interesting tool for defining a more rationale approach for research in this field.