Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis.
BACKGROUND
Protein-energy malnutrition occurs commonly in patients receiving hemodialysis (HD). Although serum albumin (sAlb) is recommended to monitor nutrition status in patients receiving HD, many processes unrelated to nutrition status can affect albumin concentrations.


METHODS
We previously showed normalized protein catabolic rate (nPCR) to be superior to sAlb to reflect improvement in nutrition status in pediatric patients receiving maintenance HD after treatment with intradialytic parenteral nutrition for severe protein-energy malnutrition. We now compare nPCR and sAlb as nutrition status markers for pediatric patients on HD irrespective of current nutrition status.


RESULTS
Forty-four patients comprising 840 months of HD provision were assessed. nPCR was higher for younger patients. Mean nPCR values were significantly lower for adolescent patients with persistent weight loss of at least 2% for at least 3 consecutive months versus patients without persistent weight loss (1.03 +/- 0.29 g/kg/d vs. 1.15 +/- 0.27 g/kg/d, P < .002), and the odds for developing persistent weight loss were four times greater for adolescent patients with nPCR less than 1 g/kg/d. No association between nPCR and weight loss was observed for younger patients. Mean sAlb levels were greater than 4 g/dL for all patient age groups and did not demonstrate a clinically significant difference between patients with or without weight loss.


CONCLUSIONS
We suggest that nPCR may be useful for monthly nutrition status in adolescent patients receiving maintenance HD and that adolescents with nPCR less than 1 g/kg/d may be at increased risk for subsequent weight loss.
Juarez-Congelosi
Marisa
M
Texas Children's Hospital, Houston, Texas 77030, USA.
Orellana
Pamela
P
Goldstein
Stuart L
SL
D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome; D015431:Weight Loss
D015415:Biomarkers; D011506:Proteins; D012709:Serum Albumin