Growth in Very Young Children Undergoing Chronic Peritoneal Dialysis

Abstract

Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at Ͻ24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG 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 and increased 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 last observation (P Ͻ 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P Ͻ 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal 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 very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth.

Chronic peritoneal dialysis in Chinese infants and children younger than two years

“…The IPDN recently analysed growth in 153 very young children on CPD. 27 Interestingly, htSDS decreased further in the first 6 to 12 months of CPD and then stabilised. Although catch-up in height was noted in the NAPRTCS report, such improvement was only observed in children with worse baseline height deficit, defined as htSDS ≤ -1.88.…”

“…In the recent IPDN study on growth, 37% young children were fed on demand, 39% by NG tube, 7% by gastrostomy tube, and 17% switched from NG to gastrostomy feeding. 27 Both NG and gastrostomy feeding led to significant increase in body mass index SDS, although regional variation was observed. Gastrostomy but not NG feeding was associated with improved linear growth, an effect that was no longer significant after adjusting the baseline length.…”

“…27 Growth during this period largely relies on nutritional intake, rather than growth hormone. Growth in ESRD is often impaired because of poor appetite, increased circulatory leptin, nutritional loss through peritoneal dialysate and repeated vomiting due to dysmotility, gastroesophageal reflux, and raised intraperitoneal pressure.…”

“…Growth in ESRD is often impaired because of poor appetite, increased circulatory leptin, nutritional loss through peritoneal dialysate and repeated vomiting due to dysmotility, gastroesophageal reflux, and raised intraperitoneal pressure. 15,27 Infants can lose more than 2 htSDS that can be irreversible. 15 Importantly, it is also a period of catch-up growth; NAPRTCS reported improvement in both htSDS and wtSDS in children who started dialysis before the age of 2 years-htSDS improved from -2.59 at baseline to -2.15 at 24 months post-dialysis, while wtSDS improved from -2.26 to -1.05.…”

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

“…[35][36][37] Por outro lado, a dificuldade na recuperação ponderal e do IMC notada na maioria dos doentes foi mais grave naqueles que se encontravam há mais tempo em DP, refletindo a dificuldade na sua otimização nutricional.…”