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Peritoneal Transport Properties and Dialysis Dose Affect Growth and Nutritional Status in Children on Chronic Peritoneal Dialysis

FRANZ SCHAEFER^*, GÜNTER KLAUS, OTTO MEHLS^* and THE MID-EUROPEAN PEDIATRIC PERITONEAL DIALYSIS STUDY GROUP^,A

^* Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
Pediatric Nephrology Division, University Children's Hospital, Marburg, Germany

Correspondence to Dr. Franz Schaefer, Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 150, 69120 Heidelberg, Germany. Phone: +49 6221 56 2396; Fax: +49 6221 56 4203; E-mail: franz_schaefer{at}med.uni-heidelberg.de

Abstract

Abstract. To evaluate a possible effect of peritoneal transport properties and dialysis dose on the physical development of children on chronic peritoneal dialysis, a cohort of 51 children was prospectively followed for 18 mo. Peritoneal transport characteristics were assessed by serial peritoneal equilibration tests (PET), dialysis efficacy by dialysate and residual renal clearance measurements, and growth and nutritional status by the longitudinal changes () of height SD score (SDS), body mass index (BMI) SDS, and serum albumin. height SDS was negatively correlated with the creatinine equilibration rate observed in the initial PET (r = -0.31, P < 0.05). Multiple regression analysis confirmed the negative effect of the high transporter state (partial r² = 0.07), and disclosed an additional positive effect of dialytic C_Cr (partial r² = 0.11) and a weak negative effect of daily dialysate volume (partial r² = 0.04) on height SDS. BMI SDS was strongly age-dependent (r = -0.48, P < 0.001); while relative body mass gradually increased below 4 yr of age, it remained stable in older children. Positive changes in BMI SDS were associated with rapid PET creatinine equilibration rates (univariate r = 0.35, P < 0.05) and/or large dialysate volumes (multivariate partial r² = 0.11), suggesting a role of dialytic glucose uptake in the development of obesity. The change in serum albumin concentrations was positively correlated with dialysate volume (partial r² = 0.14), and negatively affected by dialytic protein losses (partial r² = 0.06). In conclusion, the peritoneal transporter state is a weak but significant determinant of growth and body mass gain in children on chronic peritoneal dialysis. Rapid small solute equilibration contributes to impaired growth but enhanced acquisition of body mass. Dialytic small solute clearance has a weak positive effect on statural growth independent of the transporter state, but does not affect body mass gain.

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