ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: SA-PO465

Impact of Fluid Overload on Growth of Low-Weight Children (<15 kg) Undergoing Chronic Hemodialysis

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Henriques, Cristina, Hospital Samaritano, Sao Paulo, Brazil
  • Vieira, Simone, Hospital Samaritano, Sao Paulo, Brazil
  • Komi, Shirlei, Hospital Samaritano, Sao Paulo, Brazil
  • Carvalho, Maria fernanda Camargo, Hospital Samaritano, Sao Paulo, Brazil
  • Koch nogueira, Paulo Cesar, UNIFESP, Sao Paulo, Brazil
Background

To assess whether fluid overload estimated by interdialytic weight gain (IWG) in low-weight children on hemodialysis (HD) impacts patient growth.

Methods

Prospective cohort study of 43 patients (11F and 32M) with weight <15 kg. 91% of patients underwent daily HD. IWG was defined as the difference between pre-HD weight and estimated dry weight of the patient, expressed as percentage of weight. IWG was estimated at each HD session and the median of all values during follow-up was then calculated for each individual.
The following procedures were adopted to estimate possible effect of IWG on patient growth: a) Growth during the 6-month follow-up period was calculated, defined as the delta between the repeated measures of the Z-score of height for age parameter (first measure minus second measure).

Results

Median follow-up time was 151 days (IQR = 141 to 153 days). At study baseline, median patient age was 2.0 years (IQR = 0.8 to 2.9) and median Z-score for weight/age was -3.0 (IQR= -4.5 to -2.4). Median Z-score for height/age was -3.8 (IQR = -5.2 to -2.6) at study baseline and -3.5 (IQR=-4.8 to -2.8) at end of follow-up, a difference that was not statistically significant for the overall sample (p=0.365).
The assessment of IWG of all patients at 6 months revealed a median of 2.8% (IQR 0.0% – 6.2%). Patients were classified according to IWG into: a) High IWG, where 20 patients had IWG exceeding the median (>2.8%); and b) Low IWG, where 23 patients had IWG lower than the median (<2.8%).
Comparison of height delta revealed 0.22 (-0.02 to 0.53) in the Low IWG group versus -0.12 (-0.31 to 0.24) in the High IWG group, a statistically significant difference (p=0.030) indicating impaired growth in the children with High IWG.
On the repeated measures model using the GEE, a significant difference (p=0.026) in slope of Z-score of height for age curves was evident between groups with Low IWG=0.3 (SE=0.1) and High IWG=-0.1 (SE=0.1).

Conclusion

Besides the specific factors of CKD that lead to growth deficit, High IWG can negatively impact growth, representing a further factor impairing height in these patients. Hypervolemia promotes greater energy expenditure and contributes to systemic inflammation, leading directly or indirectly to greater protein-calorie depletion.