Advertisement

Pediatric Nephrology

, Volume 8, Issue 6, pp 733–738 | Cite as

Growth of children following the initiation of dialysis: a comparison of three dialysis modalities

  • Bruce A. Kaiser
  • Martin S. Polinsky
  • Jean Stover
  • Bruce Z. Morgenstern
  • H. Jorge Baluarte
Original Article

Abstract

Maintenance dialysis usually serves as an interim treatment for children with end-stage renal disease (ESRD) until transplantation can take place. Some children, however, may require dialytic support for an extended period of time. Although dialysis improves some of the problems associated with growth failure in ESRD (acidosis, uremia, calcium, and phosphorus imbalance), many children continue to grow poorly. Therefore, three different dialysis modalities, continuous ambulatory peritoneal dialysis (CAPD), cycler/intermittent peritoneal dialysis (CPD), and hemodialysis (HD), were evaluated with regard to their effects on the growth of children initiating dialysis and remaining on that modality for 6–12 months. Growth was best for children undergoing CAPD when compared with the other two modalities with regard to the following growth parameters: incremental height standard deviation score for chronological age [−0.55±2.06 vs. −1.69±1.22 for CPD (P<0.05) and −1.80±1.13 for HD (P<0.05)]; incremental height standard deviation score for bone age [−1.68±1.71 vs. −2.45±1.43 for CPD (P=NS) and −2.03±1.28 for HD (P=NS)]; change in height standard deviation score during the dialysis period [0.00±0.67 vs. −0.15±.29 for CPD (P=NS) and −0.23±.23 for HD (P=NS)]. The reasons why growth appears to be best in children receiving CAPD may be related to its metabolic benefits: lower levels of uremia, as reflected by the blood urea nitrogen [50±12 vs. 69±16 mg/dl for CPD (P<0.5) and 89±17 for HD (P<0.05)], improved metabolic acidosis, as indicated by a higher serum bicarbonate concentration [24±2 mEq/l vs. 22±2 for CPD (P<0.05) and 21±2 for HD (P<0.05)]. In addition, children undergoing CAPD receive significant supplemental calories from the glucose absorbed during dialysis. CAPD, and possibly, other types of prolonged-dwell daily peritoneal dialysis appear to be most beneficial for growth, which may be of particular importance for the smaller child undergoing dialysis while awaiting transplantation.

Key words

Growth Hemodialysis Continuous ambulatory peritoneal dialysis Cycler/intermittent peritoneal dialysis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    West CD, Smith WC (1956) An attempt to elucidate the cause of growth retardation in renal disease. Am J Dis Child 91: 460–476Google Scholar
  2. 2.
    Potter DE, Greifer I (1978) Statural growth of children with renal disease. Kidney Int 14: 334–339Google Scholar
  3. 3.
    Broyer M (1982) Growth in children with renal insufficiency. Pediatr Clin North Am 29: 991–1001Google Scholar
  4. 4.
    Rizzoni G, Broyer M, Guest G, Fine R, Holliday MA (1986) Growth retardation in children with chronic renal disease. Scope of the problem. Am J Kidney Dis 7: 256–261Google Scholar
  5. 5.
    Gilli G, Scharer K, Mehls O (1984) Adult height in pediatric patients with chronic renal failure. Proc Eur Dial Transplant Assoc 21: 830–836Google Scholar
  6. 6.
    Henning P, Tomlinson L, Rigden SPA, Haycock GB, Chantler C (1988) Long term outcome of treatment of end stage renal failure. Arch Dis Child 63: 35–40Google Scholar
  7. 7.
    Simmons JM, Wilson CJ, Potter DE, Holliday MA (1971) Relation of calorie deficiency to growth failure in children on hemodialysis and the growth response to calorie supplementation. N Engl J Med 285: 653–656Google Scholar
  8. 8.
    Betts PR, Magrath G, White RHR (1977) Role of dietary energy supplementation in growth of children with chronic renal insufficiency. BMJ 1: 416–418Google Scholar
  9. 9.
    Chantler C, Bishti M, Counahan R (1980) Nutritional therapy in children with chronic renal failure. Am J Clin Nutr 33: 1682–1689Google Scholar
  10. 10.
    Holliday MA (1986) Nutrition therapy in renal disease. Kidney Int 30: S3-S6Google Scholar
  11. 11.
    Wassner SJ, Abitbol C, Alexander S, Conley S, Grupe WE, Holliday MA, Rigden S, Salusky IB (1986) Nutritional requirements for infants with renal failure. Am J Kidney Dis 7: 300–305Google Scholar
  12. 12.
    Cooke RE, Boyden DG, Haller E (1960) The relationship of acidosis and growth retardation. J Pediatr 57: 326–337Google Scholar
  13. 13.
    Tsuru N, Chan JCM (1987) Growth failure in children with metabolic alkalosis and with metabolic acidosis. Nephron 45: 182–185Google Scholar
  14. 14.
    Scharer K, Gilli G (1984) Growth in children with chronic renal insufficiency. In: Fine R, Gruskin A (eds) End stage renal disease in children. Saunders, Philadelphia, pp 271–290Google Scholar
  15. 15.
    Kleinknecht C, Salusky I, Broyer M, Gubler M-C (1979) Effect of various protein diets on growth, renal function, and survival of uremic rats. Kidney Int 15: 534–541Google Scholar
  16. 16.
    Broyer M, Guillot M, Niaudet P, Kleinknecht C, Dartois AM, Jean G (1983) Comparison of three low-nitrogen diets containing essential amino acids and their alpha analogues for severely uremic children. Kidney Int 24 [Suppl 16]: S290-S294Google Scholar
  17. 17.
    Mehls O, Ritz E (1983) Skeletal growth in experimental uremia. Kidney Int 24 [Suppl 15]: S53-S62Google Scholar
  18. 18.
    Hodson EM, Shaw PF, Evans RA, Dunstan CR, Hills EE, Wong SYP, Rosenberg AR, Roy RL (1983) Growth retardation and renal osteodystrophy in children with chronic renal failure. J Pediatr 103: 735–740Google Scholar
  19. 19.
    Chesney RW, Mehls O, Anast CA, Brown E, Hammerman MR, Portale A, Fallon MD, Mahan J, Alfrey AC (1986) Renal osteodystrophy in children: the role of vitamin D, phosphorus, and parathyroid hormone. Am J Kidney Dis 7: 275–284Google Scholar
  20. 20.
    Holliday MA, Kulin HE, Lockwood DH, Rosenfeld RG (1986) The endocrine control of growth in children with chronic renal failure. Am J Kidney Dis 7: 262–267Google Scholar
  21. 21.
    Mehls O, Ritz E, Gilli G, Heinrich U (1986) Role of hormonal disturbances in uremic growth failure. Contrib Nephrol 50: 119–129Google Scholar
  22. 22.
    Chesney RW (1987) Growth retardation in childhood renal disease: a hormonal or nutritional problem? Am J Nephrol 7: 253–256Google Scholar
  23. 23.
    Korsch BM, Negrete VF (1984) Psychosocial adaptation of children with ESRD: factors affecting rehabilitation. In: Fine R, Gruskin A (eds) End stage renal disease in children. Saunders, Philadelphia, pp 553–559Google Scholar
  24. 24.
    Fine RN (1990) Growth in children with renal insufficiency. In: Nissenson AR, Fine RN, Gentile DE (eds) Clinical dialysis. 2nd edn. Appleton and Lange, Norwalk, pp 667–676Google Scholar
  25. 25.
    Fine RN (1985) Renal transplantation for children — the only realistic choice. Kidney Int 28 [Suppl 17]: S15-S17Google Scholar
  26. 26.
    Kleinknecht C, Broyer M, Gagnadoux MF, Martihenneberg C, Dartois AM, Kermanach C, Pouliquen M, Degoulet P, Usberti M, Roy MP (1980) Growth in children treated with long-term dialysis. A study of 76 patients. Adv Nephrol 9: 133–164Google Scholar
  27. 27.
    Baum M, Powell D, Calvin S, McDaid T, McHenry K, Mar H, Potter D (1982) Continuous ambulatory peritoneal dialysis in children. Comparison with hemodialysis. N Engl J Med 307: 1537–1542Google Scholar
  28. 28.
    Stefanidis CJ, Hewitt IK, Balfe JW (1983) Growth in children receiving continuous ambulatory peritoneal dialysis. J Pediatr 102: 681–685Google Scholar
  29. 29.
    Fennell RS, Orak JK, Hudson T, Garin EH, Iravani A, Van Deusen WJ, Howard R, Pfaff WW, Walker D, Richard GA (1984) Growth in children with various therapies for end-stage renal disease. Am J Dis Child 138: 28–31Google Scholar
  30. 30.
    Southwest Pediatric Nephrology Study Group (1985) Continuous ambulatory and continuous cycling peritoneal dialysis in children. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int 27: 558–564Google Scholar
  31. 31.
    Perfumo F, Verrina E, Degl'innocenti ML, Piaggio G, Gusmano R (1991) Growth in children undergoing dialysis: comparison between hemodialysis and chronic peritoneal dialysis. Acta Med Auxol 23: 45–51Google Scholar
  32. 32.
    Lilien T von, Salusky IB, Boechat I, Ettenger RB, Fine RN (1987) Five years' experience with continuous ambulatory or continuous cycling peritoneal dialysis in children. J Pediatr 111: 513–518Google Scholar
  33. 33.
    Warady BA, Kriley M, Lovell H, Farrell SE, Hellerstein S (1988) Growth and development of infants with end-stage renal disease receiving long-term peritoneal dialysis. J Pediatr 112: 714–719Google Scholar
  34. 34.
    Alexander ST, Lindblad AS, Nolph KD, Novak JW (1989) Pediatric CAPD/CCPD in the United States. In: Steinjh (ed) New concepts and applications. Contemp Issues Nephrol 22: 231–255Google Scholar
  35. 35.
    Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, StanfordGoogle Scholar
  36. 36.
    Potter DE, Broyer M, Chantler C, Gruskin A, Holliday MA, Roche A, Schärer K, Thissen D (1978) Measurement of growth in children with renal disease. Kidney Int 14: 378–382Google Scholar
  37. 37.
    Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM (1979) Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 32: 607–629Google Scholar
  38. 38.
    Baumgartner RN, Roche AF, Himes JH (1986) Incremental growth tables: supplementary to previously published charts. Am J Clin Nutr 43: 711–722Google Scholar
  39. 39.
    National Research Council, Food and Nutrition Board (1980) Recommended dietary allowances, 9th edn. National Academy of Sciences, Washington, D.C.Google Scholar
  40. 40.
    Morgenstern B, Pyle WK, Gruskin A, Baluarte HJ, Perlman S, Polinsky M, Kaiser B (1984) Transport characteristics of the pediatric peritoneal membrane. Kidney Int 25: 259Google Scholar
  41. 41.
    Diemen-Steenvoorde R van, Donckerwolcke RA, Brackel H, Wolff ED, Wong MCJW de (1987) Growth and sexual maturation in children after kidney transplantation. J Pediatr 110: 351–356Google Scholar
  42. 42.
    Fine RN (1987) Editor's column. Growth after renal transplantation in children. J Pediatr 110: 414–416Google Scholar
  43. 43.
    Ettenger RB, Blifeld C, Prince H, Gradus DBE, Cho S, Sekiya N, Salusky IB, Fine RN (1987) The pediatric nephrologist's dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr 111: 1022–1025Google Scholar
  44. 44.
    Tejani A, Butt KMH, Rajpoot D, Gonzalez R, Buyan N, Pomrantz A, Sharma R (1989) Strategies for optimizing growth in children with kidney transplants. Transplantation 47: 229–233Google Scholar
  45. 45.
    Law CM (1987) The disability of short stature. Arch Dis Child 62: 855–859Google Scholar
  46. 46.
    Tonshoff B, Mehls O, Heinrich U, Blum WF, Ranke MB, Schauer A (1990) Growth-stimulating effects of recombinant human growth hormone in children with end-stage renal disease. J Pediatr 116: 561–566Google Scholar
  47. 47.
    Cheeck DB, Graystone JE (1978) Insulin and growth hormone: regulators of growth with particular reference to muscle. Kidney Int 14: 317–322Google Scholar
  48. 48.
    Nissensan AR, Fine RN, Gentile DE (1990) Clinical dialysis. 2nd edn. Appleton and Lange, Norwalk, pp 118–146, 319–329Google Scholar
  49. 49.
    Parker TF, Laird NM, Lowrie EG (1983) Comparison of the study groups in the National Cooperative Dialysis Study and a description of morbidity, mortality, and patient withdrawal. Kidney Int 23 [Suppl 13]: S42-S49Google Scholar

Copyright information

© IPNA 1994

Authors and Affiliations

  • Bruce A. Kaiser
    • 1
  • Martin S. Polinsky
    • 1
  • Jean Stover
    • 1
  • Bruce Z. Morgenstern
    • 1
  • H. Jorge Baluarte
    • 1
  1. 1.Department of PediatricsTemple University School of Medicine St. Christopher's Hospital for PhiladelphiaUSA

Personalised recommendations