Nutritional status in children receiving chronic peritoneal dialysis

Area of Science:

• Pediatric Nephrology
• Nutritional Science
• Dialysis Therapy

Background:

• Chronic peritoneal dialysis (CPD) is a common treatment for uremic children.
• Nutritional status in these patients is complex, influenced by uremia, dialysate glucose absorption, and nutrient losses.
• Despite potential caloric benefits, energy intake is often insufficient, and protein/amino acid losses occur.

Purpose of the Study:

• To evaluate the impact of CPD on the nutritional status of pediatric patients.
• To analyze protein, energy, and amino acid profiles in children undergoing CPD.
• To identify factors influencing anthropometric parameters and plasma/muscle amino acid levels.

Main Methods:

• Review of existing literature on pediatric CPD and nutritional status.
• Analysis of anthropometric data (weight, height, skinfold thickness, midarm circumference).
• Assessment of plasma and muscle amino acid profiles, considering dietary intake and dialysate losses.

Main Results:

• Protein intake was generally adequate, but energy intake was low in CPD children.
• Anthropometric parameters did not deteriorate during CPD, though they were more impaired in younger children.
• Plasma proteins and albumin levels were low, influenced by dietary intake and protein losses.
• Significant losses of free amino acids (AA) in dialysate were observed.
• Plasma AA profiles showed reduced branched-chain and essential AAs, with increased nonessential AAs.
• Muscle studies revealed low valine and leucine levels in children on CPD.

Conclusions:

• CPD in children presents nutritional challenges, particularly concerning energy intake and amino acid metabolism.
• While anthropometric parameters may not worsen, specific amino acid deficiencies (e.g., valine, leucine) are evident.
• Monitoring dietary intake and losses is crucial for managing nutritional status and albumin levels in pediatric CPD patients.