Growth in very young children undergoing chronic peritoneal dialysis

Abstract

Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at <24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy. Standardized body mass index (BMI) uniformly decreased during periods of demand feeding and increased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation: 26% of North American children were obese and 50% of Turkish children were malnourished at last observation (P < 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P < 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal dialysate and administration of growth hormone independently associated with improved length, even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth.

Figure 1.

Whereas both nasogastric tube (NGT) and gastrostomy (GS) feeding improve nutritional status, only GS feeding associates with stabilized linear growth in young infants undergoing CPD. The data points represent mean estimates at key time points of postnatal development, (i.e., birth, commencement of CPD, initiation and discontinuation of nasogastric tube or gastrostomy feeding, enrollment to IPPN [study entry], and last available observation). Two-dimensional error bars denote the 95% confidence intervals to mean age and SDS at the respective time point.

Figure 2.

Minor regional variation in linear growth despite major differences in nutritional control in infants undergoing CPD. Course of BMI SDS and length SDS by region in 67 European, 27 North American, 33 Latin American, and 20 Turkish children. Six children from different Asian countries are not represented. Data are mean ± 95% confidence intervals. ^aSignificant change from birth to PD start; ^bSignificant change from PD start to last observation. *P < 0.05; ***P < 0.001. Reference lines indicate the 50th (SDS = 0) and 5th (SDS = −1.645) percentiles.