Calorie Deficiency in Children on Chronic Hemodialysis and Some Effects of Calorie Supplements

Abstract

Uremic children, including those on chronic hemodialysis, often exhibit mild lassitude, are wasted, and do not grow well. The absolute volumes of the total body water and extracellular fluid compartments of children compared with adults are small, necessitating strict dietary limitations of protein, sodium potassium and water. Observed cell mass is low and extracellular volume is high, confirming clinical impression of wasting and salt retention. Food record analyses of 10 children on hemodialysis 3 times weekly indicate that within the dietary restrictions calorie intakes were approximately 50% of ideal in the 5 small children (< 110 cm in height and < 6 years old), and 70% of ideal in the 5 larger children (> 125 cm and > 10 years old). Daily calorie supplements of from 40–55% of ideal intake were taken by 3 of the small children and 2 of the larger children, increasing their total calorie intake to 75–95% ideal. The heights of 9 of the children were measured monthly for no less than 4 months, and growth velocity computed from this Growth velocity was compared to the 50th percentiles of growth increments in normal children of the same age and was expressed as a fraction of normal growth velocity for the period of observation. The 5 children given calorie supplements all grew at 0.9–1.7 of normal and the 4 non-supplemented children grew at 0.1–0.4 of normal. Protein intakes were all above recommended. These findings provide tentative evidence that calorie deficiency may be a factor in uremic growth failure, and that in the absence of other complications, some growth is possible when high density calorie supplements are provided.

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