title: nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients.
abstract: 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.
authors.affiliation: Renal Service, Texas Children's Hospital, 6621 Fannin Street, MC 3-2482, Houston 77030, USA. stuartg@bcm.tmc.edu
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Shannon
authors.initials: S
authors.lastname: Baronette
authors.forename: Tywanna Vital
authors.initials: TV
authors.lastname: Gambrell
authors.forename: Helen
authors.initials: H
authors.lastname: Currier
authors.forename: Eileen D
authors.initials: ED
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000328:Adult; D001835:Body Weight; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D010288:Parenteral Nutrition / Q000379:methods*; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011506:Proteins / Q000378:metabolism; D006435:Renal Dialysis / Q000379:methods*; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D011506:Proteins; D012709:Serum Albumin