Skip to main content

Advertisement

SpringerLink
Log in

Nutritional status and volume control in adolescents on chronic hemodialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Pediatric patients on maintenance hemodialysis (HD) are at risk of both malnutrition and fluid overload. This pilot study aimed to assess correlates of normalized protein catabolic rate (nPCR) in adolescents on chronic HD, in particular fluid status markers.

Methods

All patients aged 10–18 years on chronic HD in our center between 2017 and 2019 were enrolled. For each patient, mean nPCR was calculated and correlations with the following parameters investigated: dry body weight change in subsequent 3 months in kg (∆BW) and percentage of BW (∆BW%), change in body mass index (∆BMI), preHD systolic and diastolic blood pressure (SBP, DBP), residual urine output, biochemistry, and blood volume monitoring–derived first hour refill index (RI), calculated as ratio between ultrafiltration rate and reduction in relative blood volume in first hour of dialysis.

Results

Seventy-nine nPCR determinations were collected in 23 patients, median age 14.8 years. nPCR significantly correlated with ∆BW, ∆BW%, ∆BMI, spKT/V, and preHD serum creatinine, and negatively correlated with age, DBP SDS (r=−0.466, p=0.025) and RI (r=−0.435, p=0.043). RI was significantly higher in patients with nPCR <1 than those with nPCR above this threshold: 3.2 (1.9–4.7) vs. 1.4 (0.7–1.8) ml/kg/h/% (p=0.021). At multivariable analysis, nPCR remained positively correlated with creatinine and spKt/V, and inversely correlated with RI.

Conclusions

nPCR is a significant predictor of weight change in adolescents on maintenance HD, and seems associated with creatinine and dialysis adequacy. Inverse correlation with RI suggests possible associations between malnutrition and fluid overload, but larger prospective studies are needed to confirm this.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevinho-Becerra A, Wanner C (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73:391–398

    Article  CAS  Google Scholar 

  2. Fischbach M, Dheu C, Seuge L, Orfanos N (2009) Hemodialysis and nutritional status in children: malnutrition and cachexia. J Ren Nutr 19:91–94

    Article  CAS  PubMed  Google Scholar 

  3. Edefonti A, Paglialonga F, Picca M (2006) A prospective multicentre study of nutritional status in children on chronic peritoneal dialysis. Nephrol Dial Transplant 21:1946–1951

    Article  PubMed  Google Scholar 

  4. Mak RH, Cheung WW, Zhan JY, Shen Q, Foster BJ (2012) Cachexia and protein-energy wasting in children with chronic kidney disease. Pediatr Nephrol 27:173–181

    Article  PubMed  Google Scholar 

  5. Edefonti A, Picca M, Damiani B, Garavaglia R, Loi S, Ardissino G, Marra G, Ghio L (2001) Prevalence of malnutrition assessed by bioimpedance analysis and anthropometry in children on peritoneal dialysis. Perit Dial Int 21:172–179

    Article  CAS  PubMed  Google Scholar 

  6. Brem AS, Lambert C, Hill C, Kitsen J, Shemin DG (2002) Prevalence of protein malnutrition in children maintained on peritoneal dialysis. Pediatr Nephrol 17:527–530

    Article  PubMed  Google Scholar 

  7. Foster BJ, Leonard MB (2005) Nutrition in children with chronic kidney disease: pitfalls of popular assessment methods. Perit Dial Int 25(Suppl 3):S143–S146

    Article  PubMed  Google Scholar 

  8. Paglialonga F, Edefonti A (2009) Nutrition assessment and management in children on peritoneal dialysis. Pediatr Nephrol 24:721–730

    Article  PubMed  PubMed Central  Google Scholar 

  9. Grupe WE, Harmon WE, Spinozzi NS (1983) Protein and energy requirements in children receiving chronic hemodialysis. Kidney Int Suppl 15:S6–S10

    CAS  PubMed  Google Scholar 

  10. Harmon WE, Spinozzi NS, Sargent JR, Grupe WE (1979) Determination of protein catabolic rate (PCR) in children on hemodialysis by urea kinetic modelling. Pediatr Res 13:513–517

    Google Scholar 

  11. National Kidney Foundation Kidney Disease Quality Outcome Initiative (K/DOQI) (2009) Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update. Am J Kidney Dis 53(Suppl 2):S1–S123

    Google Scholar 

  12. Borah MF, Schoenfeld PY, Gotch FA, Sargent JA, Wolfsen M, Humphreys MH (1978) Nitrogen balance during intermittent dialysis therapy of uremia. Kidney Int 14:491–500

    Article  CAS  PubMed  Google Scholar 

  13. Goldstein SL, Baronette S, Vital Gambrell T, Currier H, Brewer ED (2002) nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients. Pediatr Nephrol 17:531–534

    Article  PubMed  Google Scholar 

  14. Juarez-Congelosi M, Orellana P, Goldstein SL (2007) Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J Ren Nutr 17:269–274

    Article  PubMed  Google Scholar 

  15. Orellana P, Juarez-Congelosi M, Goldstein SL (2005) Intradialytic parenteral nutrition treatment and biochemical marker assessment for malnutrition in adolescent maintenance hemodialysis patients. J Ren Nutr 15:312–317

    Article  PubMed  Google Scholar 

  16. Haskin O, Sutherland SM, Wong CJ (2017) The effect of intradialytic intralipid therapy in pediatric hemodialysis patients. J Ren Nutr 27:132–137

    Article  CAS  PubMed  Google Scholar 

  17. Rees LO, Shaw V (2009) Nutrition in children with CRF and on dialysis. Pediatr Nephrol 24:475–484

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, Öztürk E, Usvyat L, Kotanko P, Kooman JP (2018) Interactions between malnutrition, inflammation, and fluid overload and their associations with survival in prevalent hemodialysis Patients. J Ren Nutr 28:435–444

    Article  PubMed  Google Scholar 

  19. Demirci MS, Demirci C, Ozdogan O, Kircelli F, Akcicek F, Basci A, Ok E, Ozkahya M (2011) Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients. Nephrol Dial Transplant 26:1708–1716

    Article  PubMed  Google Scholar 

  20. Kang SH, Do JY (2020) Effects of volume status on body composition in incident peritoneal dialysis patients. Eur J Clin Nutr 74:633–641

    Article  CAS  PubMed  Google Scholar 

  21. Cheng LT, Tang W, Wang T (2005) Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis 45:891–902

    Article  PubMed  Google Scholar 

  22. Guo Q, Yi C, Li J, Wu X, Yang X, Yu X (2013) Prevalence and risk factors of fluid overload in Southern Chinese continuous ambulatory peritoneal dialysis patients. PLoS One 8:e53294

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Paglialonga F, Consolo S, Galli MA, Testa S, Edefonti A (2015) Interdialytic weight gain in oligoanuric children and adolescents on chronic hemodialysis. Pediatr Nephrol 30:999–1005

    Article  PubMed  Google Scholar 

  24. Fischbach M, Zaloszyc A, Shroff R (2015) The interdialytic weight gain: a simple marker of left ventricular hypertrophy in children on chronic haemodialysis. Pediatr Nephrol 30:859–863

    Article  PubMed  Google Scholar 

  25. Flythe JE, Chang TI, Gallagher MP, Lindley E, Madero M, Sarafidis PA, Unruh ML, Wang AY, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Polkinghorne KR, Conference Participants (2020) Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 97:861–876

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hayes W, Paglialonga F (2019) Assessment and management of fluid overload in children on dialysis. Pediatr Nephrol 34:233–242

    Article  PubMed  Google Scholar 

  27. Milani GP, Groothoff JW, Vianello FA, Fossali EF, Paglialonga F, Edefonti A, Agostoni C, Consonni D, van Harskamp D, van Goudoever JB, Schierbeek H, Oosterveld MJ (2017) Bioimpedance and fluid status in children and adolescents treated with dialysis. Am J Kidney Dis 69:428–435

    Article  PubMed  Google Scholar 

  28. Paglialonga F, Consolo S, Edefonti A, Montini G (2018) The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis. Pediatr Nephrol 33:1209–1214

    Article  PubMed  Google Scholar 

  29. Depner TA, Daugirdas JT (1996) Equations for normalized protein catabolic rate based on two-point modeling of hemodialysis urea kinetics. J Am Soc Nephrol 7:780–785

    Article  CAS  PubMed  Google Scholar 

  30. Paglialonga F, Ardissino G, Galli MA, Scarfia RV, Testa S, Edefonti A (2012) Bioimpedance analysis and cardiovascular status in pediatric patients on chronic hemodialysis. Hemodial Int 16(Suppl 1):S20–S25

    Article  PubMed  Google Scholar 

  31. Paglialonga F, Lopopolo A, Scarfia RV, Galli MA, Consolo S, Brivio A, Grassi MR, Salera S, Edefonti A (2013) Correlates of exercise capacity in pediatric patients on chronic hemodialysis. J Ren Nutr 23:380–386

    Article  PubMed  Google Scholar 

  32. Marsenic O, Peco-Antić A, Jovanović O (2001) Effect of dialysis dose on nutritional status of children on chronic hemodialysis. Nephron 88:273–275

    Article  CAS  PubMed  Google Scholar 

  33. Cano FJ, Azocar MA, Delucchi MA, Rodriguez EE, Marin VS, Diaz ED, Mazuel N (2004) Nitrogen balance studies and Kt/V urea in children undergoing chronic peritoneal dialysis. Adv Perit Dial 20:245–250

    PubMed  Google Scholar 

  34. van Hoeck KJ, Rusthoven E, Vermeylen L, Vandesompel A, Marescau B, Lilien M, Schroder CH (2003) Nutritional effects of increasing dialysis dose by adding an icodextrin daytime dwell to Nocturnal Intermittent Peritoneal Dialysis (NIPD) in children. Nephrol Dial Transplant 18:1383–1387

    Article  PubMed  CAS  Google Scholar 

  35. Buur T, Smye SW, Bradbury M, Will EJ (1995) The correlation between protein catabolic rate and Kt/V in hemodialysis is not a mathematical artifact. Int J Artif Organs 18:351–354

    Article  CAS  PubMed  Google Scholar 

  36. Agarwal R, Kelley K, Light RP (2008) Diagnostic utility of blood volume monitoring in hemodialysis patients. Am J Kidney Dis 51:242–254

    Article  PubMed  Google Scholar 

  37. Maduell F, Arias M, Massó E, Fontseré N, Carrera M, Vera M, Cases A, Campistol JM (2013) Sensitivity of blood volume monitoring for fluid status assessment in hemodialysis patients. Blood Purif 35:202–208

    Article  CAS  PubMed  Google Scholar 

  38. Koomans HA, Geers AB, Mees EJ (1984) Plasma volume recovery after ultrafiltration in patients with chronic renal failure. Kidney Int 26:848–854

    Article  CAS  PubMed  Google Scholar 

  39. Wizemann V, Leibinger A, Mueller K, Nilson A (1995) Influence of hydration state on plasma volume changes during ultrafiltration. Artif Organs 19:416–419

    Article  CAS  PubMed  Google Scholar 

  40. Guzzo I, Mancini E, Kengne Wafo S, Ravà L, Picca S (2009) Residual renal function and nutrition in young patients on chronic hemodialysis. Pediatr Nephrol 24:1391–1397

    Article  PubMed  Google Scholar 

  41. Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) On line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 25:867–873

    Article  CAS  PubMed  Google Scholar 

  42. Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Ağbaş A, Aitkenhead H, Anarat A, Aoun B, Aofolaju D, Bakkaloglu SA, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Deanfield J, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stronach L, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schmitt CP, Schaefer F (2019) Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, Heart and Height Study. J Am Soc Nephrol 30:678–691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy

    Fabio Paglialonga, Silvia Consolo, Marta Brambilla, Olga Caporale & Giovanni Montini

  2. Hospital Universitario Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

    Alejandro Cruz Gual

  3. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Maria Rosa Grassi & Giovanni Montini

Authors
  1. Fabio Paglialonga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Consolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marta Brambilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olga Caporale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alejandro Cruz Gual
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Rosa Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanni Montini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FP and SC contributed to the study conception and design. Data collection was performed by FP, SC, MA, and OC. Data analysis was performed by FP. The first draft of the manuscript was written by FP and revised by SC, MB, OC, MRG, and GM. Each author contributed important intellectual content during manuscript drafting or revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Paglialonga.

Ethics declarations

The study was approved by the local Institutional Review Board and conformed to the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

Graphical abstract: Nutritional status and volume control in adolescents on chronic hemodialysis (PPTX 55 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paglialonga, F., Consolo, S., Brambilla, M. et al. Nutritional status and volume control in adolescents on chronic hemodialysis. Pediatr Nephrol 36, 3733–3740 (2021). https://doi.org/10.1007/s00467-021-05089-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-021-05089-6

Keywords

Search

Navigation