title: Can dialysis adequacy be achieved by tailoring the dialysis prescription in an Asian pediatric population on nightly intermittent peritoneal dialysis?
abstract: This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline in residual renal function and was attributable to significant improvements in the peritoneal clearances of urea and creatinine (p < 0.05). The mid arm muscle circumference (MAMC) increased significantly (p = 0.006), while FFM increased from 25.68 +/- 7.92 kg to 26.95 +/- 9.83 kg, and %FAT decreased from 21.56% +/- 8.41% to 18.66% +/- 8.16%. The increase in FFM correlated significantly with a decrease in serum creatinine (r = -0.94, p = 0.005). In conclusion, tailoring the dialysis prescription in NIPD, without adding high-dose therapy, resulted in a trend of improvement in dialysis adequacy and some nutritional parameters.
authors.affiliation: Department of Pediatrics, National University of Singapore, Singapore.
authors.forename: W K
authors.initials: WK
authors.lastname: Gong
authors.forename: P P
authors.initials: PP
authors.lastname: Foong
authors.forename: S
authors.initials: S
authors.lastname: Ramirez
authors.forename: B
authors.initials: B
authors.lastname: Murugasu
authors.forename: H K
authors.initials: HK
authors.lastname: Yap
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000592:standards*; D055656:Prescriptions; D012846:Singapore; D014508:Urea / Q000378:metabolism
chemical_list: D014508:Urea; D003404:Creatinine