Growth in Very Young Children Undergoing Chronic Peritoneal Dialysis

LESLEY REES; MARTA AZOCAR; GARRAMUÑO VALLÉS , PATRICIA; BRADLEY A. WARADY; FRANZ SCHAEFER

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY

AMER SOC NEPHROLOGY

Año: 2011 vol. 22 p. 2303 - 2312

1046-6673

ABSTRACTVery young children with chronic kidney disease often have difficulty maintaining adequate nutrition, whichcontributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescriptionand supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this isnot well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronicperitoneal dialysis at 24 months of age. From diagnosis to last observation, 57 patients were fed ondemand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned fromNG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy.Standardized body mass index (BMI) uniformly decreased during periods of demand feeding andincreased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation:26% of North American children were obese and 50% of Turkish children were malnourished at lastobservation (P 0.005). Body length decreased sharply during the first 6 to 12 months of life and thentended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatibleperitoneal dialysate and administration of growth hormone independently associated with improved length,even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in veryyoung children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatibledialysis fluid, and growth hormone therapy associate with improved linear growth.