Andrew M South1,2, Bonnie Fainman3, Scott M Sutherland4, Cynthia J Wong4. 1. Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA. 2. Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, North Carolina, USA. 3. Patient Access Manager, Raptor Pharmaceuticals, Novato, California, USA. 4. Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
Abstract
BACKGROUND: People undergoing haemodialysis (HD) often have poor nutrition, which in turn can contribute to worse outcomes. Inadequate nutrition has a particularly deleterious effect on growth and neurocognitive development, as well as mortality, in children and adolescents. Nutritional supplementation can improve outcomes but can be difficult to administer. OBJECTIVE: Determine the tolerability of intradialytic oral nutrition in children and adolescents. DESIGN: A cross-sectional quality improvement study in an outpatient paediatric HD unit. Intervention was intradialytic oral nutritional supplementation provided as protein bars and/or meals. SUBJECTS: Children and adolescents undergoing outpatient HD who were able to participate in surveys and eat by mouth. MEASUREMENTS: Adverse effects and symptoms on nurse- and patient-reported surveys, respectively. Relationships between the predictor variables and the outcomes were assessed using generalised estimating equations. RESULTS: The majority of children felt better after eating on dialysis (72%) with no adverse effects (80%). On unadjusted analyses and confirmed with generalised estimating equation modelling, children who reported being hungry felt better after eating on dialysis, despite being more likely to have adverse effects. CONCLUSION: The study demonstrates that our children and adolescents feel better after eating on HD with minimal adverse effects. The finding that hungry patients are more likely to feel better despite having a higher likelihood of an adverse effect demonstrates the tolerability of eating on HD. Intradialytic oral nutrition could be a safe and well-tolerated opportunity to provide supplemental nutrition to paediatric HD patients and improve outcomes.
BACKGROUND:People undergoing haemodialysis (HD) often have poor nutrition, which in turn can contribute to worse outcomes. Inadequate nutrition has a particularly deleterious effect on growth and neurocognitive development, as well as mortality, in children and adolescents. Nutritional supplementation can improve outcomes but can be difficult to administer. OBJECTIVE: Determine the tolerability of intradialytic oral nutrition in children and adolescents. DESIGN: A cross-sectional quality improvement study in an outpatient paediatric HD unit. Intervention was intradialytic oral nutritional supplementation provided as protein bars and/or meals. SUBJECTS:Children and adolescents undergoing outpatientHD who were able to participate in surveys and eat by mouth. MEASUREMENTS: Adverse effects and symptoms on nurse- and patient-reported surveys, respectively. Relationships between the predictor variables and the outcomes were assessed using generalised estimating equations. RESULTS: The majority of children felt better after eating on dialysis (72%) with no adverse effects (80%). On unadjusted analyses and confirmed with generalised estimating equation modelling, children who reported being hungry felt better after eating on dialysis, despite being more likely to have adverse effects. CONCLUSION: The study demonstrates that our children and adolescents feel better after eating on HD with minimal adverse effects. The finding that hungry patients are more likely to feel better despite having a higher likelihood of an adverse effect demonstrates the tolerability of eating on HD. Intradialytic oral nutrition could be a safe and well-tolerated opportunity to provide supplemental nutrition to paediatric HDpatients and improve outcomes.
Authors: C S Wong; D S Gipson; D L Gillen; S Emerson; T Koepsell; D J Sherrard; S L Watkins; C Stehman-Breen Journal: Am J Kidney Dis Date: 2000-10 Impact factor: 8.860
Authors: Usama Feroze; Nazanin Noori; Csaba P Kovesdy; Miklos Z Molnar; David J Martin; Astrid Reina-Patton; Debbie Benner; Rachelle Bross; Keith C Norris; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2011-04-28 Impact factor: 8.237