Predictive factors of poor nutritional status in children and young adults on chronic hemodialysis: A single center experience

##plugins.themes.academic_pro.article.sidebar##

Published Aug 1, 2025
https://doi.org/10.62438/tunismed.v103i8.5637
Download
pdf
Vol. 103 No. 8 (2025): Tunis Med Aug 2025

##plugins.themes.academic_pro.article.main##

Abir Boussetta
Pediatric Nephrology Department, Laboratory of Immunology and Immunopathology of Renal Transplantation "LR03SP01",Charles Nicolle Hospital, Tunis, Faculte of medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
https://orcid.org/0000-0002-8034-2355
Nesrine Abida
Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Faculte of medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
Manel Jellouli
Pediatric Nephrology Department, Laboratory of Immunology and Immunopathology of Renal Transplantation "LR03SP01",Charles Nicolle Hospital, Tunis, Faculte of medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
Taher Gargah
Pediatric Nephrology Department, Laboratory of Immunology and Immunopathology of Renal Transplantation "LR03SP01",Charles Nicolle Hospital, Tunis, Faculte of medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia

Abstract

Introduction-Aim: Children with kidney failure (KF) are prompt to undernutrition with subsequent growth failure. The aim of this study was to assess probable correlates of normalized protein catabolic rate (nPCR) in children on chronic hemodialysis (HD).


Methods: This prospective study included all 20-year-old or less patients undergoing chronic HD at our pediatric HD unit between 1st January 2024 and 30th April 2024. Patients included had been on HD for more than 3 months and were clinically stable. For each patient, baseline characteristics were recorded along with their echocardiogram findings. Mean nPCR was calculated and potential predictive factors were simultaneously evaluated. Our study included a univariate and a multivariate analysis. A p value less than 0.05 was considered statistically significant.


Results: A total of 40 patients were included with a mean age of 14.4 ± 3.7 years old and a sex-ratio M/F of 1.9. Twenty-two (55%) had a mean nPCR <1g/kg/day. A strong positive correlation between nPCR and the 3-months body mass index variation percentage was found with a correlation ratio of 0.82. On multivariate analysis, Patients with a single pool KT/V < 1.2 and those exhibiting left ventricular hypertrophy were more likely to have a nPCR value <1g/kg/day (OR: 7.2 and 11.1, 95% CI: 2.28 – 75.23 and 5.5-98,08, respectively). A first hour refill index > 1.7 ml/kg/h/% was also correlated with a low nPCR (Adjusted OR:5.5- 95% CI: 3.2-65.2).


Conclusion: Pressure and volume control along with dialysis adequacy are promising factors in improving....(abstract truncated at 250 words).

Keywords:

Children, Hemodialysis, protein catabolic rate , dialysis adequacy, refill index , Left ventricular hypertrophy

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Rees L. Protein energy wasting; what is it and what can we do to prevent it? Pediatr Nephrol. 2021;36:287-94.
  2. Kang SS, Chang JW, Park Y. Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis. Nutrients. 2017;9(4):399.
  3. Silverstein DM. Growth and Nutrition in Pediatric Chronic Kidney Disease. Front Pediatr. 2018;6:205.
  4. Foster BJ, Leonard MB. Nutrition in children with kidney disease: pitfalls of popular assessment methods. Perit Dial Int. 2005;25(3):S143-S146.
  5. Kaynar K, Songul Tat T, Ulusoy S, Cansiz M, Ozkan G, Gul S, Bektas O. Evaluation of nutritional parameters of hemodialysis patients. Hippokratia. 2012;16:236-40.
  6. National Kidney Foundation Kidney Disease Quality Outcome Initiative (K/DOQI). Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update. Am J Kidney Dis. 2009;53(2):S1–S123.
  7. Borah MF, Schoenfeld PY, Gotch FA, Sargent JA, Wolfsen M, Humphreys MH. Nitrogen balance during intermittent dialysis therapy of uremia. Kidney Int. 1978;14(5):491-500.
  8. Paglialonga F, Consolo S, Brambilla M, Caporale O, Gual AC, Grassi MR, et al. Nutritional status and volume control in adolescents on chronic hemodialysis. Pediatr Nephrol. 2021;36(11):3733-40.
  9. Juarez-Congelosi M, Orellana P, Goldstein SL. Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J Ren Nutr. 2007;17(4):269-74.
  10. Soetikno H, Indrasari A, Abdurahman A, Sukesi L, Bandiara R, Widiana GR. POS-619 Relationship between kt/v urea-based dialysis adequacy and normalized protein catabolic rate in hemodialysis patients in Hasan Sadikin hospital bandung. Kidney Int Rep. 2021;6(4):S270.
  11. Teixeira Nunes F, de Campos G, Xavier de Paula SM, Merhi VA, Portero-McLellan KC, da Motta DG, et al. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int. 2008;12:45-51.
  12. Al-Shibly KH, Al-Diwan JK. Effect of the dietary protein intake on urea reduction rate in patients on maintenance hemodialysis in Merjan Teaching Hospital. Med J Babylon. 2022;19:244-9.
  13. Kang SH, Do JY. Effects of volume status on body composition in incident peritoneal dialysis patients. Eur J Clin Nutr. 2020;74(4):633-41.
  14. Dekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, Öztürk E, et al. Interactions Between Malnutrition, Inflammation, and Fluid Overload and Their Associations with Survival in Prevalent Hemodialysis Patients. J Ren Nutr. 2018;28(6):435-44.
  15. Canaud B, Morena-Carrere M, Leray-Moragues H, Cristol JP. Fluid Overload and Tissue Sodium Accumulation as Main Drivers of Protein Energy Malnutrition in Dialysis Patients. Nutrients. 2022;14(21):4489.
  16. Ito Y, Sun T, Tanaka H, Yamaguchi M, Kinashi H, Sakata F, et al. Tissue Sodium Accumulation Induces Organ Inflammation and Injury in Chronic Kidney Disease. Int J Mol Sci. 2023;24(9):8329.
  17. McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL. Intensive Hemodialysis, Left Ventricular Hypertrophy, and cardiovascular disease. Am J Kidney Dis. 2016;68(5S5):S5-S14.
  18. Law JP, Pickup L, Pavlovic D, Townend JN, Ferro CJ. Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. J Hum Hypertens. 2023;37(1):1-19.
  19. Zhou C, Shi Z, Ouyang N and Ruan X. Hyperphosphatemia and cardiovascular disease. Front. Cell Dev. Biol. 2021;9:644363.
  20. Roselló-Lletí E, Rivera M, Martínez-Dolz L, González Juanatey JR, Cortés R, Jordán A, et al. Inflammatory activation and left ventricular mass in essential hypertension. Am J Hypertens. 2009;22(4):444-50.
  21. Bo S, Mandrile C, Milanesio N, Pagani A, Gentile L, Gambino R, et al. Is left ventricular hypertrophy a low-level inflammatory state? A population-based cohort study. Nutr Metab Cardiovasc Dis. 2012;22(8):668-76.
  22. Stumpf F, Keller B, Gressies C, Schuetz P. Inflammation and Nutrition: Friend or Foe? Nutrients. 2023;15(5):1159.