Intradialytic parenteral nutrition in malnourished children treated with hemodialysis.
OBJECTIVE
To examine the feasibility and effectiveness of intradialytic parenteral nutrition (IDPN) in children on hemodialysis.


METHODS
Prospective experimental study with a single intervention group.


METHODS
A pediatric hemodialysis unit.


METHODS
Four malnourished children on hemodialysis (3 girls and 1 boy) 4 to 18 years of age were studied during a period of 1 year.


METHODS
IDPN, which is composed of amino acids (8.5% solution), glucose (as 10% to 15% dextrose), and 20% fat emulsion, was administered at every dialysis session (3 times a week, during 4 hours each time) for 7 to 12 weeks.


METHODS
Oral caloric intake (evaluated by using a 3-day diet history), dry weight (weight after dialysis), body mass index, percent ideal body weight, total lymphocyte count, and serum levels of albumin before, immediately after cessation of IDPN, and 3 months after cessation of IDPN.


RESULTS
Oral caloric intake increased markedly after IDPN administration, from 5 to 63 kcal/kg/d (mean, 33 kcal/kg/d) before IDPN administration to 35 to 177 kcal/kg/d (mean, 86 kcal/kg/d) at the time of cessation. Weight did not change during the treatment period but it did increase from 9.5 to 36.4 kg (mean, 25 kg) to 11 to 39 kg (mean, 26.7 kg) 3 months later. Percent ideal body weight increased from 73% to 88% (mean, 78.5%) to 79% to 90% (mean, 85.1%), and body mass index increased from 12.2 to 15 kg/m(2) (mean, 13.5 kg/m(2)) to 13.4 to 15.5 kg/m(2) (mean, 14.6 kg/m(2)). Total lymphocyte count increased from 538 to 2,041 cells/mm(3) (mean, 1,403 cells/mm(3)) to 724 to 2,884 cells/mm(3) (mean, 2,066 cells/mm(3)). Plasma levels of albumin increased in 1 patient but remained unchanged in others.


CONCLUSIONS
Short-term IDPN treatment may serve as a safe and effective nutritional intervention in malnourished children on hemodialysis.
Krause
Irit
I
Nephrology Clinic and Dialysis Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. ikrause@post.tau.ac.il
Shamir
Raanan
R
Davidovits
Miriam
M
Frishman
Sigal
S
Cleper
Roxana
R
Gamzo
Zahava
Z
Poraz
Irit
I
Eisenstein
Bella
B
D000293:Adolescent; D015362:Child Nutrition Disorders / Q000209:etiology* / Q000628:therapy; D002675:Child, Preschool; D002149:Energy Intake; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome; D015430:Weight Gain