Children tolerate intradialytic oral nutrition

Abstract

Background Haemodialysis (HD) patients have poor nutrition, which contributes to worse outcomes. Inadequate nutrition has a particularly deleterious effect on growth and neurocognitive development, as well as mortality, in children and adolescents. Nutritional supplementation can improve outcomes but can be difficult to administer. Objective Determine the tolerability of intradialytic oral nutrition in paediatric patients. Design Cross-sectional quality improvement study in an outpatient paediatric HD unit. Intervention was intradialytic oral nutritional supplementation provided as protein bars and/or meals. Subjects Children and adolescents on outpatient HD who were able to participate in surveys and eat by mouth. Measurements Adverse effects and symptoms on nurse- and patient-reported surveys, respectively. Relationships between the predictor variables and the outcomes were assessed using generalized estimating equations. Results The majority of children felt better after eating on dialysis (72%) with no adverse effects (80%). On unadjusted analyses and confirmed with generalized estimating equation modelling, children who reported being hungry felt better after eating on dialysis (OR 4.58, 95% CI 1.5 to 13.92, p = 0.007), despite being more likely to have adverse effects (2.42, 1.0 to 5.87, p = 0.05). Conclusion The study demonstrates that our paediatric HD patients feel better after eating on HD with minimal adverse effects. The finding that hungry patients are more likely to feel better despite having a higher likelihood of an adverse effect demonstrates the tolerability of eating on HD. Intradialytic oral nutrition could be a safe and well-tolerated opportunity to provide supplemental nutrition to paediatric HD patients and improve outcomes.