Nutritional effects of increasing dialysis dose by adding an icodextrin daytime dwell to Nocturnal Intermittent Peritoneal Dialysis (NIPD) in children.
BACKGROUND
To assess the need to adapt dietary prescriptions, we studied potential effects of increasing the dialysis dose by adding a daytime icodextrin dwell, in children on Nocturnal Intermittent Peritoneal Dialysis (NIPD), on peritoneal amino acids (AA) and albumin loss, AA, albumin, cholesterol and fibrinogen plasma levels and nutritional intake.


METHODS
A cross-over study in eight children (age 2-12 years) on NIPD at baseline (week 1).


METHODS
to increase dialysis dose we added a daytime dwell with 1100 ml/m(2) icodextrin solution for a week (week 2).


METHODS
peritoneal albumin loss (quantified by nephelometry) and AA loss (quantified by liquid chromatography mass spectrometry) in the last 72 h dialysate collections of weeks 1 and 2. On days 7 and 14, morning blood sample was taken for urea, creatinine, plasma AA levels, serum albumin, cholesterol and fibrinogen determination. Nutritional intake diaries were kept throughout the study period.


RESULTS
Weekly dialysis creatinine clearance increased from 35 to 65 l/1.73 m(2) (P<0.0001) and Kt/V from 1.99 to 2.54 (P<0.01). Peritoneal albumin loss did not change significantly (2.4+/-0.4 to 2.4+/-0.3 g/m(2)/24 h) nor did serum albumin (3.25+/-0.52 to 3.21+/-0.25 g/dl), cholesterol (216+/-73 to 240+/-61 mg/dl) and fibrinogen (385+/-40 to 436+/-64 mg/dl). There was a significant increase in loss of essential (EAA) [1122+/-200 to 2104+/-417 mg/m(2)/week (P<0.0001)] and non-essential amino acids (NEAA) [6160+/-1341 to 10406+/-2899 mg/m(2)/week (P<0.001)]. Plasma AA levels did not change significantly except for a drop in histidine and glutamine. Dietary protein intake did not change from 43+/-12 to 41+/-8 g/m(2)/day, caloric intake from 73+/-21 to 70+/-24 kcal/kg/day.


CONCLUSIONS
Increasing dialysis dose by introducing a daytime icodextrin dwell during a week does not affect peritoneal albumin loss, serum albumin, cholesterol and fibrinogen levels nor dietary intake on a short term. There is a significant increase in EAA and NEAA loss without change in plasma levels. We suggest monitoring dietary intake when adding a daytime icodextrin dwell in children.
van Hoeck
Koen J M
KJ
Department of Pediatric Nephrology, University Hospital Antwerp, Belgium. koen.van.hoeck@uza.be
Rusthoven
Esther
E
Vermeylen
Linda
L
Vandesompel
Annemie
A
Marescau
Bart
B
Lilien
Marc
M
Schroder
Cornelis H
CH
D000596:Amino Acids / Q000097:blood / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004435:Eating / Q000187:drug effects; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000187:drug effects; D005936:Glucans / Q000008:administration & dosage* / Q000627:therapeutic use*; D005947:Glucose / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008297:Male; D009752:Nutritional Status / Q000187:drug effects*; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis / Q000187:drug effects
D000596:Amino Acids; D015314:Dialysis Solutions; D005936:Glucans; D012709:Serum Albumin; D000077607:Icodextrin; D005340:Fibrinogen; D002784:Cholesterol; D005947:Glucose