Hemodialysis and Nutritional Status in Children: Malnutrition and Cachexia

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Malnutrition is a common state in chronic hemodialyzed children. More than malnutrition, which infers that dietary supplementation would be curative, cachexia, which implies loss of protein stores, are combined factors of impaired linear growth and reduced muscle mass in uremic patients. Adequate diet to prevent malnutrition is of major importance. But to avoid cachexia in children on chronic hemodialysis, the management of acidosis, inflammation, abnormal metabolic rate, and endocrine disturbances should not, be forgotten. Daily hemodialysis regimen using convective flow therapy and ultrapure dialysate, i.e., on line hemodiafiltration together with growth hormone therapy, appears as a hopeful strategy for the chronic dialyzed child to achieve catch-up growth, a parameter of optimal nutrition.

Section snippets

Hemodialysis and Normalized Protein Nitrogen Appearance (Protein Catabolic Rate)

Urea kinetic in children on hemodialysis permits the calculation of urea dialytic removal and of urea generation.12 The blood urea reduction rate from start to end of the dialysis session is correlated to the dialysis dose, Kt/V, where K is the urea clearance, t is the dialysis time, and V is the total body water. The interdialytic blood urea kinetic is related to the protein nitrogen appearance (PNA), formerly called protein catabolic rate (PCR). The dietary protein intake can be estimated

Nutrition in Children on Chronic Hemodialysis

Nutritional requirements for children on dialysis are proposed2, 18 (Table 1). Protein intake should be sufficient if protein is not to become the limiting factor for growth.2 Adequate energy must be given to promote deposition of protein.2

Despite these nutritional guidelines, malnutrition occurs in children on CKD.1, 2, 8 Poor appetite is common in children on dialysis. Its mechanism is complex and multifactorial,19, 20 including abnormal taste sensation, endocrine disturbances especially in

Conclusion

Malnutrition is common in hemodialysis children. An adequate diet to avoid malnutrition is of importance. But improvement in the appetite is difficult with all the dietary restrictions induced by the thrice-weekly dialysis regimen, especially in anuric children. Nevertheless, cachexia is also implicated in the pathogenesis of impaired linear growth and muscle wasting in hemodialysis children. Therefore, adequate nutrition is not always sufficient to obtain normal body development. Daily and

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    Copyright © 2009 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.