A prospective multicentre study of the nutritional status in children on chronic peritoneal dialysis

Abstract

The anthropometry-bioimpedance analysis-nutrition (ABN) score is a recently proposed objective method of assessing malnutrition in children on chronic peritoneal dialysis (CPD) that uses nine parameters based on anthropometry, skinfold thickness and bioimpedance analysis. The aim of this prospective, cross-sectional study was to apply it to children treated with CPD in seven Italian paediatric nephrology centres, with a score of < 10.33 (the 3rd percentile in a population of 264 healthy children) classifying the children as malnourished. The other considered parameters were age, age at the start of dialysis and duration of dialysis; serum haemoglobin, urea, creatinine, total protein, albumin, transferrin, bicarbonate and C-reactive protein; residual urine output; urinary and peritoneal creatinine clearance; and daily protein and energy intake. The study enrolled 43 patients (mean age 10.2 +/- 4.2 years), 21 of whom (48.8%) had an ABN score of < 10.33: 15 with mild, five with moderate, and one with severe malnutrition. The malnourished patients started CPD at a younger age (P < 0.05) and had a longer duration of dialysis (P < 0.01), and a significant worsening in nutritional status was observed in those treated for more than 12 months of dialysis; they also had significantly lower serum albumin, creatinine and haemoglobin levels. In conclusion, protein-calorie malnutrition is common in children receiving CPD. A younger age at the start of dialysis and a longer duration of treatment are clear risk factors, and counterbalance the long-term viability of CPD in paediatric age.

Growth and PTH in prepubertal children on long-term dialysis

“…However, despite this, growth was maintained in our patients, without further decline in HtSDS after starting dialysis. Other reports of growth on dialysis vary from demonstrating an improvement in HtSDS [6,13]; to no change [14]; or to a fall in HtSDS [3]. Nevertheless, our results demonstrate that nearly 50% of our patients have a HtSDS<−2SD when entering our dialysis programme.…”

Nutrition in children with CRF and on dialysis

“…However, catch-up can occur, even on dialysis [47–49]. Poor nutritional status is associated with starting PD at a younger age [50]. Interestingly, infants who grew well continued with catch-up in early childhood [43, 47].…”

“…Increasing severity of CRF adversely affects growth: when the patients were divided into those with a GFR greater or less than 25 ml/min/1.73 m 2 , the HtSDS was −1.65 and −2.79, respectively [44]. Reports of growth on dialysis vary from improvement [54], to no change [55] to declining HtSDS [56], with a worsening of nutritional status in children dialysed for more than a year [50]. …”

Peritoneal Dialysis in Children

“…Edefonti et al [85] proposed an anthropometry-bioimpedance analysis-nutrition (ABN) score based on nine anthropometry and BIA parameters, expressed as SDS and elaborated by means of a dedicated software program to calculate an ABN score that may vary from 3 to 15. Distribution percentiles were calculated in healthy children, and an ABN score of 10.33 was established as the low limit of normal (3rd percentile).…”

“…Distribution percentiles were calculated in healthy children, and an ABN score of 10.33 was established as the low limit of normal (3rd percentile). A multicenter study on PD pediatric patients showed that 48.8 % of them had an ABN score lower than 10.33 as well as significantly lower levels of serum albumin, hemoglobin, and creatinine [85]. Therefore, the ABN score seems a valuable tool for monitoring nutritional status in children on chronic PD; further validation, however, is still needed.…”