title: Two-point normalized protein catabolic rate overestimates nPCR in pediatric hemodialysis patients.
abstract: BACKGROUND
  Normalized protein catabolic rate (nPCR) calculation depends on estimating the urea generation between consecutive hemodialysis (HD) treatments. Two-point nPCR using blood urea nitrogen (BUN) before and after the same HD treatment has not been validated in pediatric patients, who typically receive a more intense HD dose than adults. This study aimed to compare nPCR calculated with a two-point vs. a three-point nPCR model in pediatric HD patients.
  
  
  METHODS
  Pediatric patients receiving HD at 2 units were enrolled. Three BUN measurements were obtained around a midweek HD treatment: one prior to HD (preBUN1), one 30 s after HD (30sBUN), and one prior to the subsequent HD (preBUN2). The two-point nPCR model was calculated using preBUN1 and 30sBUN and the three-point nPCR model was calculated using preBUN2 and 30sBUN.
  
  
  RESULTS
  Seventy-six BUN sets from 35 patients were analyzed. Mean age was 16.4 ± 3.5 years. Mean dry weight was 51.4 ± 17.1 kg. Mean spKt/V was 1.54 ± 0.23. Mean preBUN2 was significantly lower than mean preBUN1 (60.2 ± 18.6 vs. 64.0 ± 18.9 mg/dl, p = 0.0001). nPCR obtained from the three-point model was significantly lower than nPCR obtained from the two-point model (1.07 ± 0.31 vs. 1.17 ± 0.31 g/kg/day, p = 0.00001). Seven of 76 (9.2 %) paired comparisons yielded three-point nPCR <1 vs. two-point nPCR >1.
  
  
  CONCLUSIONS
  Our data show that in pediatric patients receiving HD, the ((1) two-point and three-point models lead to significantly different nPCRs, and (2) inaccurate protein intake assessment may result from reliance on a two-point model for nPCR estimates.
authors.affiliation: Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA. srivaths@bcm.edu
authors.forename: Poyyapakkam R
authors.initials: PR
authors.lastname: Srivaths
authors.forename: Scott
authors.initials: S
authors.lastname: Sutherland
authors.forename: Steven
authors.initials: S
authors.lastname: Alexander
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002140:California; D004044:Dietary Proteins / Q000378:metabolism*; D006801:Humans; D008954:Models, Biological; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins