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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.