nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients

Goldstein, Stuart L.; Baronette, Shannon; Gambrell, Tywanna Vital; Currier, Helen; Brewer, Eileen D.

doi:10.1007/s00467-002-0925-z

Cited by 71 publications

(36 citation statements)

References 19 publications

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“…Indeed, although albumin often has been used to assess nutrition in adult dialysis patients (18,33), studies in children reveal that serum albumin may be affected by hydration and therefore may not be a consistently reliable indicator of nutritional status (34). Moreover, data from our own unit show serum albumin to be a very poor nutrition status marker in children who have severe protein energy malnutrition and respond to aggressive therapy with intradialytic parenteral nutrition (35,36).…”

Section: Discussionmentioning

confidence: 94%

Pro- and Anti-Inflammatory Cytokines in Chronic Pediatric Dialysis Patients

Goldstein¹,

Leung²,

Silverstein³

2006

Clinical Journal of the American Society of Nephrology

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Dialysis provides effective and safe treatment of ESRD in children, but patients who are maintained on chronic dialysis are at risk for cardiovascular disease. One major risk factor for cardiovascular disease in adult patients with ESRD is chronic inflammation. The effect of anti-inflammatory therapy with aspirin on serum cytokine concentration was studied in seven children who were receiving hemodialysis (HD) and seven who were receiving continuous cycling peritoneal dialysis (CCPD or PD). A lthough the advent of dialysis provides effective and safe treatment of ESRD in pediatric patients, children who are maintained on long-term dialysis are at risk for significant cardiovascular disease (CVD). Although many CVD risk factors have not been studied in the pediatric dialysis population, studies in adult patients with ESRD demonstrate that cardiovascular calcifications and inflammation (1), abnormal calcium-phosphorus metabolism (2), and malnutrition (3) play a role in CVD development.A burgeoning area of research in the past decade has focused on the role of inflammation in dialysis patients. Inflammation, mediated by proinflammatory cytokines, contributes substantially to morbidity and mortality (4 -8) in adult patients with ESRD. We previously showed that the proinflammatory cytokines IL-1␤ and TNF-␣ increased significantly after hemodialysis (HD), whereas there was only a mild increase in the antiinflammatory cytokine IL-10, suggesting an imbalance of cytokine production favoring the proinflammatory response. Consistent with the enhanced inflammatory state were the elevated C-reactive protein levels in a majority of the patients whom we studied (9) and that the degree of inflammation correlated with the number of years that patients lived with ESRD (dialysis vintage). A recent study showed that there is increased oxidant stress and early cardiovascular damage in children with various stages of renal insufficiency, although the cohort included only a small number of patients who were receiving dialysis (10). On the basis of our previous studies, we decided to perform a pilot study to assess the anti-inflammatory capacity of daily, low-dosage aspirin on serum cytokine concentrations in children who were receiving maintenance HD or peritoneal dialysis (PD). Materials and Methods PatientsAll patients who had been receiving either maintenance HD or continuous cycling PD (CCPD) for at least two consecutive months in the Texas Children's Hospital Renal Dialysis Unit were eligible to enroll in the study. Informed consent was obtained from each patient's parent, and assent was obtained from each patient who was older than 14 yr before study enrollment. The Institutional Review Boards from both Baylor College of Medicine and Louisiana State University Health Sciences Center approved the study protocol before its initiation. Patients were selected to ensure inclusion of a wide spectrum of pediatric ages, with similar mean age and range between the two groups that were receiving HD and PD. Patients were excluded from the ...

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Section: Discussionmentioning

confidence: 94%

Pro- and Anti-Inflammatory Cytokines in Chronic Pediatric Dialysis Patients

Goldstein¹,

Leung²,

Silverstein³

2006

Clinical Journal of the American Society of Nephrology

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“…Pediatric patients on hemodialysis with severe growth failure have a 3-fold increase in mortality compared with the same age cohorts (24,25). Supplementation of nutrition via intradialytic parenteral nutrition has been successfully used to reverse weight loss and to promote weight gain for pediatric hemodialysis patients (26,27). Enteral nutrition is safe in most adult patients with AKI; moreover, those on renal replacement therapy may require higher protein as intravenous infusions to compensate for protein losses in the dialysate (28).…”

Section: Discussionmentioning

confidence: 99%

Nutrition Support among Critically Ill Children with AKI

Kyle

Akcan-Arikan

Orellana

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground Critically ill children are at high risk of underfeeding and AKI, which may lead to further nutritional deficiencies. This study aimed to determine the adequacy of nutrition support during the first 5 days of intensive care unit (ICU) stay. Results Of the 167 patients, 102 were male and 65 were female (median age 1.4 years). Using the RIFLE criteria, 102 (61%) patients had no AKI, whereas 44 (26%) were classified as category R (risk), 12 (7%) as category I (injury), and 9 (5%) as category F (failure). The median 5-day energy intake was lower relative to estimated BMR. Overall protein provision (19%) was lower than energy provision (55%) compared with estimated needs (P,0.001). I/F patients were more likely to be fasted versus receiving enteral/parenteral nutrition (n=813 patient days) and to receive ,90% of BMR (n=832 patient days) than No AKI/R patients.Conclusions Underfeeding, common in critically ill children, was accentuated in AKI. Protein underfeeding was greater than energy underfeeding in the first 5 days of PICU stay. Efforts should be made to provide adequate nutrition in ICU patients with AKI.

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“…Recent medical and technological advances have improved the physical well-being of patients with end-stage renal disease (ESRD) [1,2]. For adult patients, outcomes research has focused upon the effect of improved anemia status with recombinant erythropoietin and intravenous iron therapy, improved urea clearance as measured by Kt/V and the benefit of exercise upon patient mortality, hospitalization and functional status [3,4].…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life in pediatric patients with ESRD

et al. 2006

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As part of creating a pediatric ESRD-specific Health-Related Quality of Life (HRQOL) assessment instrument, we established pilot data with the PedsQL 4.0 Generic Core Scales in 96 pediatric patients with ESRD receiving hemodialysis (HD), peritoneal dialysis (PD) or with a renal transplant (TX). Patient age ranges were: 2-4 (8; PD n=3, TX n=5), 5-7 (12; HD n=9, TX n=3), 8-12 (25; HD n=5, PD n=6, TX n=14), 13-18 (51; HD n=18, PD n=10, TX n=23). PedsQL ESRD data were compared to healthy children (n=131 child report; n=145 parent report) and across HD/PD/TX. For all domains, ESRD patient HRQOL scores were significantly lower than healthy controls. Transplant patients reported better physical and psychosocial health than dialysis patients. No difference was noted between HD and PD patients for any PedsQL domain. Our data demonstrate that the PedsQL 4.0 Generic Core Scales is a useful measurement instrument to screen for HRQOL impairment in pediatric patients with ESRD. We suggest that the ESRD-specific HRQOL instrument in development is needed to help define condition-specific HRQOL differences between modalities.

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nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients

Cited by 71 publications

References 19 publications

Pro- and Anti-Inflammatory Cytokines in Chronic Pediatric Dialysis Patients

Pro- and Anti-Inflammatory Cytokines in Chronic Pediatric Dialysis Patients

Nutrition Support among Critically Ill Children with AKI

Health-related quality of life in pediatric patients with ESRD

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