GROWTH OF CHILDREN FOLLOWING THE INITIATION OF DIALYSIS - A COMPARISON OF 3 DIALYSIS MODALITIES

Maintenance dialysis usually serves as an interim treatment for childr en with end-stage renal disease (ESRD) until transplantation can take place. Some children, however, may require dialytic support for an ext ended period of time. Although dialysis improves some of the problems associated with growth failure in ESRD (acidosis, uremia, calcium, and phosphorus imbalance), many children continue to grow poorly. Therefo re, three different dialysis modalities, continuous ambulatory periton eal dialysis (CAPD), cycler/intermittent peritoneal dialysis (CPD), an d hemodialysis (HD), were evaluated with regard to their effects on th e growth of children initiating dialysis and remaining on that modalit y for 6-12 months. Growth was best for children undergoing CAPD when c ompared with the other two modalities with regard to the following gro wth parameters: incremental height standard deviation score for chrono logical age [-0.55+/-2.06 vs. -1.69+/-1.22 for CPD (P <0.05) and -1.80 +/-1.13 for HD (P <0.05)]; incremental height standard deviation score for bone age [-1.68+/-1.71 vs. -2.45+/-1.43 for CPD (P = NS) and -2.0 3+/-1.28 for HD (P = NS)]; change in height standard deviation score d uring the dialysis period [0.00+/-0.67 vs. -0.15+/-.29 for CPD (P = NS ) and -0.23+/-.23 for HD (P = NS)]. The reasons why growth appears to be best in children receiving CAPD may be related to its metabolic ben efits: lower levels of uremia, as reflected by the blood urea nitrogen [50+/-12 vs. 69+/-16 mg/dl for CPD (P <0.5) and 89+/-17 for HD (P <0. 05)], improved metabolic acidosis, as indicated by a higher serum bica rbonate concentration [24+/-2 mEq/l vs. 22+/-2 for CPD (P <0.05) and 2 1+/-2 for HD (P <0.05)]. In addition, children undergoing CAPD receive significant supplemental calories from the glucose absorbed during di alysis. CAPD, and possibly, other types of prolonged-dwell daily perit oneal dialysis appear to be most beneficial for growth, which may be o f particular importance for the smaller child undergoing dialysis whil e awaiting transplantation.