Growth in very young children undergoing chronic peritoneal dialysis.
Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at <24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy. Standardized body mass index (BMI) uniformly decreased during periods of demand feeding and increased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation: 26% of North American children were obese and 50% of Turkish children were malnourished at last observation (P < 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P < 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal dialysate and administration of growth hormone independently associated with improved length, even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth.
Renal Office, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, United Kingdom. Reesl@gosh.nhs.uk
Lesley
L
Rees
Marta
M
Azocar
Dagmara
D
Borzych
Alan R
AR
Watson
Anja
A
Büscher
Alberto
A
Edefonti
Ilmay
I
Bilge
David
D
Askenazi
Giovanna
G
Leozappa
Claudia
C
Gonzales
Koen
K
van Hoeck
Donna
D
Secker
Aleksandra
A
Zurowska
Kai
K
Rönnholm
Antonia H M
AH
Bouts
Heather
H
Stewart
Gema
G
Ariceta
Bruno
B
Ranchin
Bradley A
BA
Warady
Franz
F
Schaefer
D049628:Body Size; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010530:Peritoneal Dialysis; D011446:Prospective Studies