Clinicians look at predictors for kidney disease among children
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New research is helping to define the warning signs that children are at risk for developing kidney disease, according to a recently published study.
While the percentage of children and young people who have severe kidney disease and require renal replacement therapy (RRT) is relatively low (approximately 2%), the burden of dialysis can have a major impact on a childhood.
“Unlike adults, young patients have higher metabolic and nutritional demands due to continuous growth,” pediatric nephrologist Olivera Marsenic, MD, a co-author on the study, told Healio Nephrology. “Failure to maintain optimal nutrition results in malnutrition and hypoalbuminemia sooner than would be expected in adult patients. Standard chronic dialysis provided three times per week, while a life-saving measure, is not sufficient to create physiologic milieu needed for optimal growth and development.”
Young patients with end-stage kidney disease who are on hemodialysis are also more prone to organ ischemic injury because of the aggressive fluid removal during dialysis. “They have relatively high fluid intake needs necessary to meet their nutritional requirements that allow growth, which in turn result in higher need for fluid removal by [hemodialysis] HD,” Marsenic said.
Children requiring dialysis have an approximately 55-fold mortality risk compared to a healthy population of the same age, according to a press release about the study issued by the European Renal Association-European Dialysis and Transplant Association. “Duration of dialysis and the age at the start of dialysis are generally considered to be risk factors, but these are factors that cannot be influenced,” the group wrote.
In the study, the authors reviewed data that originated from a cohort of patients (n = 363) younger than 30 years of age who started HD in childhood (≤19 years). Dialysis was provided in outpatient DaVita dialysis clinics between 2004 and 2016. Patients with at least 5 years of follow-up since the initiation of HD or death were included in the review.
In the study, 105 variables relating to demographics, hemodialysis treatment and laboratory measurements for their significance as predictors of 5-year mortality were evaluated.
“The results showed that low albumin and elevated lactate dehydrogenase were the two important risk factors,” according to the press release. Other factors also had an impact, including a reduced red blood cell count, hemoglobin, albumin/globulin ratio, ultra-filtration rate, z-score weight for age or inadequate dialysis dose (spKt/V below target, according to the release.
Marsenic told Healio Nephrology that both hypoalbuminemia and elevated LDH “can be seen early in the course of chronic HD therapy, especially in smaller patients and at the ages when growth spurt is expected, yet we may see growth retardation and weight loss. For best outcomes in this population, early intervention is necessary.
“… [W]e need to implement intensified HD therapy such as more frequent HD, longer HD sessions and routine hemodiafiltration. These strategies were shown to result in better removal of metabolic and inflammatory waste products, as well as less aggressive removal of retained fluid. Such interventions allow higher nutritional and fluid intake, and a more physiologic environment needed to support the metabolic and growth demands of young patients.”
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