Residual renal function and nutrition in young patients on chronic hemodialysis

Abstract

Residual renal function (RRF) has been associated with a better nutritional status in adult patients on chronic dialysis, but there is as yet no data available for young patients on chronic hemodialysis (HD). We have retrospectively analyzed 3-day dietary reports and simultaneous urea kinetic monitoring data (n = 179) of 30 children, adolescents and young adults on chronic HD. The protein catabolic rate (PCR) was calculated and normalized by body weight (nPCR). The HD dialysis dose (Kt/VHD), RRF (calculated by urea clearance, Ku, and expressed as residual Kt/V) and total Kt/V (Kt/Vtot) were evaluated. In all patients, nPCR was correlated with dietary protein intake (nDPI) (p < 0.0001) and Kt/Vtot (p < 0.0001) but not with Kt/VHD (p = 0.11). In patients with RRF, Ku was associated with nPCR (p < 0.0001), while Kt/VHD was not (p = 0.10), and nPCR was higher than in patients without RRF (1.46 +/- 0.41 vs. 1.03 +/- 0.33 g/kg/day; p < 0.0001). Patients on recombinant growth hormone (rhGH) treatment showed higher nPCR values than those without rhGH (1.34 +/- 0.41 vs. 1.01 +/- 0.39 g/kg/day; p < 0.0001). In a multiple regression model including age, rhGH treatment, RRF, Kt/Vtot and Kt/VHD, and nPCR showed the best correlation with RRF (beta = 0.128; p < 0.0001). In conclusion, in children, adolescents and young adults on chronic HD treatment, RRF positively affects nutrition independently of HD efficiency and rhGH treatment.

Genotype/Phenotype Correlation in Nephrotic Syndrome Caused by WT1 Mutations

“…The initial suggestion for a preventive nephrectomy in patients with DDS was published in the pre-era of genetic screening for WT1 mutations (32). The drawbacks of a preventive nephrectomy are the additive risk of a bilateral nephrectomy procedure and the potential loss of residual renal function in CKD stage 5 patients (33,34). In light of our findings, we suggest a flow chart, for the risk evaluation and surveillance of patients with NS and WT1 mutations, that can provide guidance when counseling parents of children with NS and WT1 mutations (Figure 2).…”

Malnutrition in Children With Chronic Disease

“…Both remaining kidney function and increased dialysis correlate with improved growth. Higher dialysis creatine clearance is associated with improved growth and increased protein intake for children on peritoneal dialysis and those on hemodialysis . Early nutrition intervention in CKD is also associated with improved growth .…”

Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis

“…RRF appears to be particularly important in dialyzed children, where it has been associated with better nutritional status and growth, cardiovascular function, and survival. 21 , 22 , 23 , 24 Congenital anomalies of kidney and urinary tract (CAKUT) are the leading cause of end-stage renal disease (ESRD) in children, and these disorders are typically characterized by the preservation of high urine output even in CKD stage V. In addition, peritoneal dialysis (PD), which tends to preserve RRF better than hemodialysis, 4 , 9 , 25 , 26 , 27 is the dialysis modality of first choice in children.…”