Efficacy of Gastrostomy Feeding in Infants and Older Children Receiving Chronic Peritoneal Dialysis

Abstract

Objective To assess the efficacy of supplemental gastrostomy tube (g-tube) feeding in infants and children receiving chronic peritoneal dialysis (CPD). Design Retrospective observational study. Setting Pediatric nephrology division of tertiary care center. Patients Fifteen patients undergoing g-tube insertion while receiving CPD were included in the study, and were subdivided, on the basis of age, into the following groups: infants (≤ 2.5 years, n = 8); older children (> 2.5 years, n = 7). Main Outcome Measures Assessment of the effect of CPD and g-tube feeding on statural growth assessed by height standard deviation score (SDS) and percentage weight-for-height, and measured anthropometric variables including triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), and midarm mean circumference (MAC). Assessment of the effects of CPD and g-tube feeding on measured biochemical variables including total protein, albumin, cholesterol, triglycerides, and high density lipoprotein. Results No significant change in height SDS was observed; however, the reported continuing decline in height SDS in infants was arrested. Percentage weight-for-height increased significantly in infants at 6 months ( p = 0.008) and 12 months ( p = 0.006) following initiation of g-tube feeding. An increase was also observed in the older child group, being significant at 12 months ( p = 0.031) following g-tube insertion. Increases in all anthropometric variables occurred in the infant group during CPD and post g-tube insertion, significant only for MAMC at 12 months ( p = 0.037) post g-tube insertion. In older children little change occurred during CPD, with all variables increasing post g-tube insertion, significant only for MAMC at 6 months ( p = 0.02) and 12 months ( p = 0.02). An increase in total protein and albumin was noted; however, no significant changes in any biochemical parameters were observed. Conclusions Supplemental g-tube feeding facilitates weight gain in infants and older children receiving CPD and arrests the decline in height SDS traditionally observed in infants with end-stage renal disease. No significant alteration was observed in measured biochemical variables, although an increase in total protein and albumin was noted.

Recent Advances in Understanding the Malnutrition‐Inflammation‐Cachexia Syndrome in Chronic Kidney Disease Patients: What is Next?

“…A number of methods have been tried to improve nutritional status in dialysis patients (Table 1). Tube feeding, which has been employed especially among pediatric, elderly, and disabled individuals (35–38), is a cumbersome modality and cannot be imposed on the average (stable and functional) CKD outpatient. Parenteral interventions, including intradialytic parenteral nutrition (IDPN), are quite costly and can be utilized only during dialysis treatment (39,40).…”

Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

“…These factors cause difficulties when assessing and comparing outcomes. Studies are summarised in Table 1 [3,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and divided according to whether there has been an improvement, no change, or a deterioration in growth. The majority of studies are in the very young.…”

Percutaneous Endoscopic Gastrostomy with Jejunal Extension Tube for the Delivery of Levodopa Carbidopa Intestinal Gel: Clinical Practice Guidelines of the Romanian Society of Digestive Endoscopy

“…The presence of mild to moderate ascites does no longer represent a contraindication, as an increased rate of complications has not been demonstrated under these circumstances [15]. Peritoneal dialysis treatment is also not a contraindication for the use of a PEG tube [16,17]. Oesophageal stenoses, previously considered a contraindication, can be nowdays passed by a very thin endoscope (direct puncture technique) or can be treated with endoscopic dilatation (pull technique).…”

“…As the endoscopic insertion of an enteral feeding tube represents an elective invasive procedure, it is essential to obtain legally valid consent [16]. The nature and scope of the information should be provided to the patient; the related documentation should follow the general guidelines for obtaining informed consent from patients prior to other endoscopic procedures.…”