Body size in children with chronic kidney disease after gastrostomy tube feeding

Abstract

Outcome body size of gastrostomy tube (g-tube)-fed children with chronic kidney disease (CKD) was investigated. CKD patients, stages 2-5, who had a g-tube inserted and removed between 1985 and 2007 were retrospectively reviewed (n=20) for anthropometrics, lab values, and steroid use from insertion to latest date. CKD patients never having had a g-tube placed (n=82) acted as the comparison population with similar data collection at start and end of the latest 5-year period. Body mass index (BMI)-for-age, weight (Wt)-for-age, and height (Ht)-for-age z scores were calculated and compared between groups. Median age at insertion and duration of g-tube treatment was 1.7 years (range 0.9-15.6), and 2.9 years (range 0.9-11.8), respectively. There was a significant increase in Wt- (p<0.01), and BMI-for-age (p<0.03) z score, but not for Ht-for-age between insertion and removal for subjects. There were no significant differences in Ht-, Wt-, or BMI-for-age z scores, from removal to 5 years post-removal. In the comparison population, there were no significant differences in Ht-, Wt-, or BMI-for-age z scores over the 5-year period. Approximately 36% of the non-tube-fed comparison population and 50% of the tube-fed subjects were overweight or obese at the most recent evaluation. In both subjects and the comparison group, overweight and obesity is associated with transplant status and steroid use. G-tube feeding is an effective method for achieving catch-up weight and moderate height gain in pediatric CKD patients, and does not apparently predispose patients to obesity after removal; however, overweight and obesity may pose problems to children with CKD whether or not they are tube fed.

Wasting in chronic kidney disease

“…However, there is no evidence that children will grow better if their intake exceeds recommended amounts for healthy children. Gastrostomy tube feeding leads to improvement in weight and BMI‐for‐age z scores but not height‐for‐age z scores in children with advanced CKD , , .…”

Malnutrition in Children With Chronic Disease

“…Children with CKD and protein‐energy wasting have increased risk of hospitalization . Malnutrition in CKD is not limited to undernutrition, as obesity is also seen in patients with CKD . In children with CKD on dialysis, decreased height, being underweight, and being overweight have all been associated with increased risk of mortality …”

Cachexia and protein-energy wasting in children with chronic kidney disease

“…There is ample evidence to support the effectiveness of supplemental calories in promoting growth in children with CKD up to about 2 years of age [48]. However, calorie intake is generally appropriate for body size in older children with CKD, and there is no evidence that supplemental calories promote growth in the older age group [49]…”