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Body composition in children on regular hemodialysis
Insights
Children with chronic renal failure (CRF) undergoing hemodialysis show altered body composition. Pre-pubertal children exhibit decreased body cell mass and fat-free solids, suggesting impaired energy metabolism and potential benefits from carbohydrate supplementation.
Area of Science:
- Pediatric Nephrology
- Body Composition Analysis
- Metabolic Disorders
Background:
- Chronic renal failure (CRF) significantly impacts growth and development in children.
- Body composition abnormalities are common in pediatric patients with CRF on hemodialysis.
Purpose of the Study:
- To assess body composition differences in pubertal versus pre-pubertal children with CRF undergoing hemodialysis.
- To investigate the relationship between body water compartments, cell mass, and fat content in this population.
Main Methods:
- Body composition was evaluated in 19 children (7 pre-pubertal, 12 pubertal) aged 7-17 years on regular hemodialysis.
- Measurements included total body water (TBW), extracellular water (ECW), and intracellular water (ICW).
- Fat-free solids (FFS) and total body fat were estimated and compared to predicted values.
Main Results:
- Both groups showed normal TBW and increased ECW.
- Intracellular water (ICW) and FFS were significantly decreased in pre-pubertal children, but not in pubertal children.
- Total body fat was normal in both groups, but higher in pre-pubertal children, with some showing increased fat alongside decreased cell mass.
Conclusions:
- CRF and hemodialysis lead to distinct body composition changes, particularly affecting cell mass and FFS in pre-pubertal children.
- Impaired energy metabolism may contribute to protein depletion, with potential benefits from carbohydrate supplementation in pre-pubertal patients.
- These findings highlight the need for tailored nutritional and metabolic interventions in pediatric CRF patients based on developmental stage.
Abstract:
Body composition was estimated in 12 pubertal and 7 pre-pubertal children (age range 7-17 years) on regular hemodialysis for chronic renal failure (CRF). The results were expressed as a ratio of observed/predicted. Total body water (TBW) was normal and extracellular water (ECW) was significantly increased in both groups. Intracellular water (ICW), which reflects body cell mass, was significantly decreased in the pre-pubertal children but not in the pubertal children. The deviation in ICW from predicted normal was significantly more marked in the prepubertal children compared with pubertal children. Similarly, fat-free solids (FFS) were significantly decreased in the pre-pubertal, but normal in the pubertal children. Total body fat, estimated from body water, correlated significantly with skinfold thickness measurements and was normal in both groups, with the pre-pubertal children having significantly higher body fat ratio than pubertal children. Body fat was increased in some of the patients whose body cell mass was decreased. It is suggested that these changes are the result of a failure of normal energy metabolism with consequent body protein depletion, and that energy supplements as carbohydrate, particularly in the pre-pubertal patients, will increase body fat without affecting cell mass.