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01-07-2009 | Original Article

Residual renal function and nutrition in young patients on chronic hemodialysis

Authors: Isabella Guzzo, Elvira Mancini, Séverin Kengne Wafo, Lucilla Ravà, Stefano Picca

Published in: Pediatric Nephrology | Issue 7/2009

Abstract

Residual renal function (RRF) has been associated with a better nutritional status in adult patients on chronic dialysis, but there is as yet no data available for young patients on chronic hemodialysis (HD). We have retrospectively analyzed 3-day dietary reports and simultaneous urea kinetic monitoring data (n = 179) of 30 children, adolescents and young adults on chronic HD. The protein catabolic rate (PCR) was calculated and normalized by body weight (nPCR). The HD dialysis dose (Kt/VHD), RRF (calculated by urea clearance, Ku, and expressed as residual Kt/V) and total Kt/V (Kt/Vtot) were evaluated. In all patients, nPCR was correlated with dietary protein intake (nDPI) (p < 0.0001) and Kt/Vtot (p < 0.0001) but not with Kt/VHD (p = 0.11). In patients with RRF, Ku was associated with nPCR (p < 0.0001), while Kt/VHD was not (p = 0.10), and nPCR was higher than in patients without RRF (1.46 ± 0.41 vs. 1.03 ± 0.33 g/kg/day; p < 0.0001). Patients on recombinant growth hormone (rhGH) treatment showed higher nPCR values than those without rhGH (1.34 ± 0.41 vs. 1.01 ± 0.39 g/kg/day; p < 0.0001). In a multiple regression model including age, rhGH treatment, RRF, Kt/Vtot and Kt/VHD, and nPCR showed the best correlation with RRF (β = 0.128; p < 0.0001). In conclusion, in children, adolescents and young adults on chronic HD treatment, RRF positively affects nutrition independently of HD efficiency and rhGH treatment.

Schulman G (2004) The dose of dialysis in hemodialysis patients: impact on nutrition. Semin Dial 17:479–488PubMed

Marcén R, Teruel JL, de la Cal MA, Gamez C (1997) The impact of malnutrition in morbidity and mortality in stable haemodialysis patients. The Spanish Cooperative Study of Nutrition in Hemodialysis. Nephrol Dial Transplant 12:2324–2331PubMed

Bergström J (1995) Nutrition and mortality in hemodialysis. J Am Soc Nephrol 6:1329–1341PubMed

Peritoneal Dialysis Study Group (1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 7:198–207

Acchiardo SE, Moore LW, Latour PA (1983) Malnutrition as the main factor in morbidity and mortality of hemodialysis patients. Kidney Int 24:S199–S203

Laird NM, Berkey CS, Lowrie EG (1983) Modeling success or failure of dialysis therapy. The National Cooperative Dialysis Study. Kidney Int Suppl 13:S101–S106

National Kidney Foundation (2000) Clinical practice guidelines for nutrition in chronic renal failure. Guideline 15. Am J Kidney Dis 35:S2–S40

Tattersall J, Martin-Malo A, Pedrini L, Basci A, Canaud B, Fouque D, Haage P, Konner K, Kooman J, Pizzarelli F, Tordoir J, Vennegoor M, Wanner C, ter Wee P, Vanholder R (2007) European best practice guidelines on haemodialysis. Nephrol Dial Transplant 22[Suppl 2]:ii5–ii21PubMed

Lindsay RM, Spanner E, Heidenheim RP, LeFebvre JM, Hodsman A, Baird J, Allison ME (1992) Which comes first Kt/V or PCR—Chicken or egg? Kidney Int Suppl 38:S32–S36PubMed

10.

Azar AT, Wahba K, Mohamed AS, Massoud WA (2007) Association between dialysis dose improvement and nutritional status among hemodialysis patients. Am J Nephrol 27:113–119PubMed

11.

Panagoutsos SA, Yannatos EV, Passadakis PS, Thodis ED, Galtsidopoulos OG, Vargemezis VA (2002) Effects of hemodialysis dose on anemia, hypertension, and nutrition. Ren Fail 24:615–621PubMed

12.

Rocco MV, Dwyer JT, Larive B, Greene T, Cockram DB, Chumlea WC, Kusek JW, Leung J, Burrowes JD, McLeroy SL, Poole D, Uhlin L, HEMO Study Group (2004) The effect of dialysis dose and membrane flux on nutritional parameters in hemodialysis patients: results of the HEMO Study. Kidney Int 65:2321–2334PubMed

13.

Marsenic O, Peco-Antić A, Jovanović O (2001) Effect of dialysis dose on nutritional status of children on chronic hemodialysis. Nephron 88:273–275PubMed

14.

Tom A, McCauley L, Bell L, Rodd C, Espinosa P, Yu G, Yu J, Girardin C, Sharma A (1999) Growth during maintenance hemodialysis: Impact of enhanced nutrition and clearance. J Pediatr 134:464–471PubMed

15.

National Kidney Foundation (2000) K/DOQI guidelines clinical practice guidelines for hemodialysis adequacy. Guideline 8. Pediatric hemodialysis prescription and adequacy. National Kidney Foundation, New York

16.

Cano FJ, Azocar MA, Delucchi MA, Rodriguez EE, Marin VS, Diaz ED, Mazuel N (2004) Nitrogen balance studies and Kt/V urea in children undergoing chronic peritoneal dialysis. Adv Perit Dial 20:245–250PubMed

17.

Cano F, Azocar M, Cavada G, Delucchi A, Marin V, Rodriguez E (2006) Kt/V and nPNA in pediatric peritoneal dialysis: a clinical or a mathematical association. Pediatr Nephrol 21:114–118PubMed

18.

Fischbach M, Terzic J, Lahlou A, Burger MC, Eyer D, Desprez P, Geisert J (1995) Nutritional effects of KT/V in children on peritoneal dialysis: are there benefits from larger dialysis doses? Adv Perit Dial 11:306–308PubMed

19.

Krediet RT (2006) How to preserve residual renal function in patients with chronic kidney disease and on dialysis. Nephrol Dial Transplant 21[Suppl 2]:ii42–ii46PubMed

20.

Bargman JM, Thorpe KE, Churchill DN for the CANUSA Peritoneal Dialysis Study Group (2001) Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 12:2158–2162PubMed

21.

Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S, Mexican Nephrology Collaborative Study Group (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13:1307–1320PubMed

22.

Pagé DE, Knoll GA (2003) Partial explanation for the surprising ADEMEX result. Adv Perit Dial 19:73–76PubMed

23.

Wang AY, Woo J, Wang M, Sea MM, Sanderson JE, Lui SF, Li PK (2005) Important differentiation of factors that predict outcome in peritoneal dialysis patients with different degrees of residual renal function. Nephrol Dial Transplant 20:396–403PubMed

24.

Chadha V, Blowey DL, Warady BA (2001) Is growth a valid outcome measure of dialysis clearance in children undergoing peritoneal dialysis? Perit Dial Int 21[Suppl 3]:S179–S184PubMed

25.

Suda T, Hiroshige K, Ohta T, Watanabe Y, Iwamoto M, Kanegae K, Ohtani A, Nakashima Y (2000) The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients. Nephrol Dial Transplant 15:396–401PubMed

26.

Shemin D, Bostom AG, Lambert C, Hill C, Kitsen J, Kliger AS (2000) Residual renal function in a large cohort of peritoneal dialysis patients: change over time, impact on mortality and nutrition. Perit Dial Int 20:392–395

27.

Wang AY, Sea MM, Ip R, Law MC, Chow KM, Lui SF, Li PK, Woo J (2001) Independent effects of residual renal function and dialysis adequacy on actual dietary protein, calorie, and other nutrient intake in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 12:2450–2457PubMed

28.

Schaefer F, Klaus G, Mehls O (1999) Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group. J Am Soc Nephrol 10:1786–1792PubMed

29.

Aranda RA, Pecoits-Filho RF, Romão JE Jr, Kakehashi E, Sabbaga E, Marcondes M, Abensur H (1999) Kt/V in children on CAPD: how much is enough. Perit Dial Int 19:588–590PubMed

30.

Morgenstern BZ, Wühl E, Nair KS, Warady BA, Schaefer F (2006) Anthropometric prediction of total body water in children who are on pediatric peritoneal dialysis. J Am Soc Nephrol 17:285–293PubMed

31.

Goldstein SL, Jabs K (2004) In: Avner ED, Harmon WE, Niaudet P (eds) Pediatric nephrology. Lippincott Williams & Wilkins, Philadelphia, pp 1401–1402

32.

Goldstein SL, Sorof JM, Brewer ED (1999) Evaluation and prediction of urea rebound and equilibrated Kt/V in the pediatric hemodialysis population. Am J Kidney Dis 34:49–54PubMed

33.

Chandna SM, Kulinskaya E, Farrington K (2005) A dramatic reduction of normalized protein catabolic rate occurs late in the course of progressive renal insufficiency. Nephrol Dial Transplant 20:2130–2138PubMed

34.

Lowrie EG (1996) Thoughts about judging dialysis treatment: mathematics and measurements, mirrors in the mind. Semin Nephrol 16:242–262PubMed

35.

Juarez-Congelosi M, Orellana P, Goldstein SL (2007) Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J Ren Nutr 17:269–274PubMed

36.

Orellana P, Juarez-Congelosi M, Goldstein SL (2005) Intradialytic parenteral nutrition treatment and biochemical marker assessment for malnutrition in adolescent maintenance hemodialysis patients. J Ren Nutr 15:312–317PubMed

37.

Moist LM, Port FK, Orzol SM (2000) Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol 11:556–564PubMed

38.

Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT for the NECOSAD study (2002) Preservation of residual renal function in patients with CKD ii45 group Predictors of the rate of decline of residual renal function in incidence dialysis patients. Kidney Int 62:1046–1053PubMed

39.

Rottembourg J, Issad B, Gallego JL (1983) Evolution of residual renal function in patients undergoing maintenance haemodialysis or continuous ambulatory peritoneal dialysis. Proc Eur Dial Transplant Assoc 19:397–403PubMed

40.

Lang SM, Bergner A, Topfer M, Schiffl H (2001) Preservation of residual renal function in dialysis patients: Effects of dialysis-technique-related factors. Perit Dial Int 21:52–57PubMed

41.

Alloatti S, Manes M, Paternoster G, Gaiter AM, Molino A, Rosati C (2000) Peritoneal dialysis compared with hemodialysis in the treatment of end-stage renal disease. J Nephrol 13:331–342PubMed

42.

Termorshuizen F, Dekker FW, van Manen JG, Korevaar JC, Boeschoten EW, Krediet RT; NECOSAD Study Group (2004) Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. J Am Soc Nephrol 15:1061–1070PubMed

43.

Feber J, Schärer K, Schaefer F, Míková M, Janda J (1994) Residual renal function in children on haemodialysis and peritoneal dialysis therapy. Pediatr Nephrol 8:579–583PubMed

44.

Chandna SM, Farrington K (2004) Residual renal function: considerations on its importance and preservation in dialysis patients. Semin Dial 17:196–201PubMed

45.

Caramelo C, Alcazar R, Gallar P, Teruel JL, Velo M, Ortega O, Galera A, Da Silva M (1994) Choice of dialysis membrane does not influence the outcome of residual renal function in haemodialysis patients. Nephrol Dial Transplant 9:675–677PubMed

46.

McCarthy JT, Jenson BM, Squillace DP, Williams AW (1997) Improved preservation of residual function in chronic hemodialysis patients using polysulfone dialyzers. Am J Kidney Dis 29:576–583PubMed

47.

McKane W, Chandna SM, Tattersall JE, Greenwood RN, Farrington K (2002) Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD. Kidney Int 61:256–265PubMed

48.

Schiffl H, Lang SM, Fischer R (2002) Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients. Nephrol Dial Transplant 17:1814–1818PubMed

49.

Li PK, Chow KM, Wong TY, Leung CB, Szeto CC (2003) Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study. Ann Intern Med 139:105–112PubMed

50.

Medcalf JF, Harris KP, Walls J (2001) Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis. Kidney Int 59:1128–1133PubMed

51.

Bragg-Gresham JL, Fissell RB, Mason NA, Bailie GR, Gillespie BW, Wizemann V, Cruz JM, Akiba T, Kurokawa K, Ramirez S, Young EW (2007) Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS). Am J Kidney Dis 49:426–431PubMed

52.

National Kidney Foundation (2000) Clinical practice guidelines for preservation of residual kidney function. Guideline 6. Am J Kidney Dis 35[Suppl 2]:S40

53.

Brooks ER, Fatallah-Shaykh SA, Langman CB, Wolf KM, Price HE (2008) Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. J Ren Nutr 18:304–311PubMed

Title: Residual renal function and nutrition in young patients on chronic hemodialysis
Authors: Isabella Guzzo
Elvira Mancini
Séverin Kengne Wafo
Lucilla Ravà
Stefano Picca
Publication date: 01-07-2009
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 7/2009
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-009-1144-7

At a glance: The STEP trials

Springer Medicine

Residual renal function and nutrition in young patients on chronic hemodialysis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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