nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients

• Published in: Pediatric nephrology (Berlin, West) Vol. 17; no. 7; pp. 531 - 534
• Main Authors: Goldstein, Stuart L, Baronette, Shannon, Gambrell, Tywanna Vital, Currier, Helen, Brewer, Eileen D
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01.07.2002
• Subjects: Adolescent; Adolescent Nutritional Physiological Phenomena; Adult; Body Weight; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Parenteral Nutrition - methods; Protein-Energy Malnutrition - diagnosis; Protein-Energy Malnutrition - etiology; Protein-Energy Malnutrition - therapy; Proteins - metabolism; Renal Dialysis - methods; Sensitivity and Specificity; Serum Albumin - metabolism
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-002-0925-z

Very few pediatric studies have monitored nutritional status using normalized protein catabolic rate (nPCR) or treating protein-energy malnutrition (PEM) with intradialytic parenteral nutrition (IDPN). The current study compares nPCR with serum albumin as a marker for nutritional status and examines the effectiveness of IDPN treatment in three malnourished adolescent patients receiving chronic hemodialysis in a pediatric dialysis unit. All patients demonstrated reversal of weight loss and initiation of weight gain within 6 weeks of IDPN initiation. Mean values of monthly percentage weight and percentage body mass index (BMI) change were significantly lower in the pre-IDPN era (-0.61+/-2.70 and -1.3+/-2.7) versus the IDPN treatment period (1.8+/-2.1 and 1.3+/-2.1) ( P<0.02). Two patients attained ideal body weight and IDPN was discontinued after 5 months. Patients required 150% recommended daily allowance to achieve weight and BMI gain. While mean monthly nPCR was significantly lower in the pre-IDPN period versus the IDPN period (1.05+/-0.36 versus 1.35+/-0.37, P<0.05), monthly serum albumin levels were no different before and after IDPN was initiated (3.7+/-0.8 versus 3.8+/-0.6). The current study demonstrates IDPN to be effective therapy for adolescent hemodialysis patients with PEM not correctable by enteral supplementation. nPCR was superior to serum albumin as a nutritional status marker in these malnourished pediatric patients receiving hemodialysis.