The literature suggests that children on chronic hemodialysis (HD) grow poorly, with a mean annual loss of approximately 0.4 standard deviations (SD) in height. We have adopted an aggressive regimen for children undergoing HD, consisting of closely monitored energy and protein intakes and longer dialysis times, with substantially higher Kt/V values than conventional recommendations. Twelve pre- or early-pubertal children (aged 7 months to 14 years) were followed for an average of 2.3 years (4-72 months) while receiving maintenance HD. Average energy and protein intakes were 139.8% and 91.2% of recommended, respectively. With a prescribed urea clearance of 5 ml/kg/min, we achieved a mean Kt/V value of 1.98 and a urea reduction ratio of 84.7%. The average time on HD was 14.8 hours per week. The annual increase in height standard deviation score (delta z) was +0.60 (+0.65 excluding the two children receiving growth hormone). Three of the patients have now achieved their final adult height and fall within their genetic target range (z= -1.4, SD =0.5). Predicted final height in those children who have not yet reached their final stature strongly suggests that they too will achieve their genetic target (z =- 0.32, SD=0.75). We show that adequate nutrition and aggressive dialysis with longer treatment times and higher Kt/V values may diminish the growth retardation in children requiring chronic HD.
