Nutritional Aspects in Children on CAPD

Bonzel, K. E.; Bonatz, Karin; Senghaas, C.; Mueller-Wiefel, Dirk E.; Wartha, R.; Gretz, Norbert; Moeller, E.; Mehls, Otto

doi:10.1007/978-3-662-11784-2_80

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…The nitrogen losses in dialysate of our patients, if expressed per kilogram body wt, were again of a similar order to those reported for adults [2][3][4] and children [5]. Nitrogen losses as protein and amino acids in dialysate accounted for an important fraction of total nitrogen losses in our series, as in others [2,5,13,[21][22][23][26][27][28]. Urinary nitrogen output is obviously related to residual renal function: all 19 patients in our first group excreted urine, which explains the higher percentage of urinary nitrogen output (16.36%) than that reported by Blumenkrantz et al (14.2%) [2,3].…”

Section: Discussionsupporting

confidence: 68%

Models to assess nitrogen losses in pediatric patients on chronic peritoneal dialysis

Edefonti¹,

Picca

Damiani

et al. 2000

Pediatr Nephrol

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To develop models to estimate nitrogen (N) losses of children on chronic peritoneal dialysis (CPD) from easily measurable indexes and laboratory tests, we measured the N content and all nitrogenous compounds in dialysate (D), urine (U), and feces over 3 days in 19 pediatric patients on CPD. Total measured N losses (TNm) were 5.56+/-2.26 g/day (69.9+/-11.1% in dialysate, 16.3+/-10.6% in urine, and 13.6+/-4.6% in feces). Correlation coefficients between measured dialysate and urinary N losses and the single nitrogenous compounds indicated values of over 0.9 only for urea in dialysate and urine; fecal N losses correlated well with body surface area (BSA). Taking into account these correlations, we developed a univariate additive model and three multivariate models to predict total estimated N losses (TNe). The best prediction of TNm was obtained with model 3, which considered not only urea output in dialysate and urine but also dialysate protein loss and BSA: TNe (g/day)=0.03+/-1.138 UN urea+0.99 DN urea+1.18 BSA+0.965 DN protein. A confirmatory analysis performed on a second group of 23 pediatric patients on CPD, using all four models, showed a higher percentage of studies with a relative difference between TNm and TNe less than 10% for model 3 than for the other models. Thus, N losses of pediatric patients on CPD can be estimated from measured urea and protein losses in dialysate and urea loss in urine, together with BSA.

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Section: Discussionsupporting

confidence: 68%

Models to assess nitrogen losses in pediatric patients on chronic peritoneal dialysis

Edefonti¹,

Picca

Damiani

et al. 2000

Pediatr Nephrol

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“…As no experiments were done prior to peritonitis, the problem arises whether the study after recovery is comparable with the baseline situation before peritonitis. Data from the literature suggest that ultrafiltration has become normal 3 weeks after peritonitis [21] and peritoneal protein loss in 1-2 weeks [22-241. The minimal interval between the two studies was 20 days in our patients.…”

Section: Discussionmentioning

confidence: 99%

Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients

Krediet

Zuyderhoudt

Boeschoten

et al. 1987

Eur J Clin Investigation

152

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The in situ intraperitoneal volume and the mass transfer area coefficients (MTC) of urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG were studied in eight continuous ambulatory peritoneal dialysis (CAPD) patients. All patients were studied during a 4-h dialysis dwell, first during peritonitis and subsequently after recovery from the infection. The maximal intraperitoneal volume was reached at 68 min during peritonitis and at 150 min in the study after recovery (P less than 0.01), suggesting increased water transport during the infection. For all investigated solutes MTCs were higher in the presence of peritonitis than after recovery. This increase was most marked for the proteins (greater than 100%). The power curve relationships between MTCs and molecular weight indicated that peritoneal transport of the low- and middle-molecular weight solutes was determined by free diffusion and that the infection-induced rise was due to an increase in effective surface area. For protein transport restricted diffusion was found. The increase of this transport during peritonitis was probably caused by both a larger effective surface area and a higher vascular permeability.

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“…Protein and calorie intakes recommended for children treated with CPD vary widely according to age. Recommended protein intakes for children on CPD are generally higher than those for normal children and those on hemodialysis, as they are based on those of normal children of the same statural age but also take into account protein losses in the dialysate [4,[10][11][12][13][14]. However, spontaneous protein and calorie intakes of children on CPD are frequently lower than recommended.…”

Section: Discussionmentioning

confidence: 99%

“…Recommended nutritional intakes vary widely in the literature, irrespective of the age of the patients, and moreover are not easily obtained in clinical practice [4,[10][11][12][13][14]. The very few studies published on N balance in children on CPD [15,16] have described the pattern of spontaneous protein and calorie intake and N output and balance, but N balance studies have never been performed to establish protein and calorie requirements of patients on PD.…”

Section: Introductionmentioning

confidence: 99%

Dietary prescription based on estimated nitrogen balance during peritoneal dialysis

Edefonti

Picca

Damiani

et al. 1999

Pediatric Nephrology

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Protein and energy requirements of children on automated peritoneal dialysis (APD) have still not been sufficiently well defined, although their adequacy is important to maintain a positive nitrogen (N) balance and prevent malnutrition. We carried out 42 studies to estimate N balance in 31 children over 3 years on APD for 19.8+/-15.7 months. Twenty metabolic studies were performed in patients dialysed for less than 1 year (7.2+/-3.3 months) and 22 in patients treated for more than 1 year (31.3+/-13.6 months). The mean estimated N balance of all metabolic studies was 57.5+/-62.8 mg/kg per day. In only 21 of 42 studies was N balance estimated to be over 50 mg/kg per day, which is considered adequate to meet N requirements for all metabolic needs and growth of uremic children. Estimated N balance correlated significantly with dietary protein intake (r=0.671, P=0.0001) and total energy intake (r=0.489, P=0.001). Using the equations of correlation, the values of dietary protein intake [=144% recommended dietary allowance (RDA)] and total energy intake (89% RDA) required to obtain an estimated N balance >50 mg/kg per day were calculated. Significantly lower estimated N balance values were obtained in the studies performed on patients on APD for over 1 year (36.09+/-54.02 mg/kg per day) than in patients treated for less than 1 year (81.11+/-64.70 mg/kg per day). In conclusion, based on the values of estimated N balance, we were able to establish adequate dietary protein and energy requirements for children on APD.

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Nutritional Aspects in Children on CAPD

Cited by 5 publications

References 10 publications

Models to assess nitrogen losses in pediatric patients on chronic peritoneal dialysis

Models to assess nitrogen losses in pediatric patients on chronic peritoneal dialysis

Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients

Dietary prescription based on estimated nitrogen balance during peritoneal dialysis

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