Nutritional status and volume control in adolescents on chronic hemodialysis

Fabio Paglialonga, Silvia Consolo, Marta Brambilla, Olga Caporale, Alejandro Cruz Gual, Maria Rosa Grassi, Giovanni Montini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pediatric patients on maintenance hemodialysis (HD) are at risk of both malnutrition and fluid overload. This pilot study aimed to assess correlates of normalized protein catabolic rate (nPCR) in adolescents on chronic HD, in particular fluid status markers. Methods: All patients aged 10–18 years on chronic HD in our center between 2017 and 2019 were enrolled. For each patient, mean nPCR was calculated and correlations with the following parameters investigated: dry body weight change in subsequent 3 months in kg (∆BW) and percentage of BW (∆BW%), change in body mass index (∆BMI), preHD systolic and diastolic blood pressure (SBP, DBP), residual urine output, biochemistry, and blood volume monitoring–derived first hour refill index (RI), calculated as ratio between ultrafiltration rate and reduction in relative blood volume in first hour of dialysis. Results: Seventy-nine nPCR determinations were collected in 23 patients, median age 14.8 years. nPCR significantly correlated with ∆BW, ∆BW%, ∆BMI, spKT/V, and preHD serum creatinine, and negatively correlated with age, DBP SDS (r=−0.466, p=0.025) and RI (r=−0.435, p=0.043). RI was significantly higher in patients with nPCR <1 than those with nPCR above this threshold: 3.2 (1.9–4.7) vs. 1.4 (0.7–1.8) ml/kg/h/% (p=0.021). At multivariable analysis, nPCR remained positively correlated with creatinine and spKt/V, and inversely correlated with RI. Conclusions: nPCR is a significant predictor of weight change in adolescents on maintenance HD, and seems associated with creatinine and dialysis adequacy. Inverse correlation with RI suggests possible associations between malnutrition and fluid overload, but larger prospective studies are needed to confirm this. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish
JournalPediatric Nephrology
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Blood volume monitoring
  • Fluid status
  • Hemodialysis
  • Pediatric dialysis
  • Protein catabolic rate
  • Refill index

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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