GASTROSTOMY BUTTONS FOR NUTRITIONAL SUPPORT ON CHRONIC DIALYSIS

Rationale. Nutritional support for children on chronic dialysis often involves the use of nasogastric tubes or gastrostomy feeding. We repor t our experience using gastrostomy buttons (GB) over a 6.6-year period to document their success/failure, the feeding regimens employed and the impact on growth. Design. In 339 patient months of prospective obs ervation, 22 children (14 male) commenced gastrostomy feeding at a med ian age of 2.3 years (range 0.2-10.3 years). Sixteen patients had an i nitial gastrostomy catheter inserted at the same time as a chronic dia lysis catheter. Eighteen patients were established on continuous cycli ng peritoneal dialysis (CCPD) and four on haemodialysis (HD). Results. The mean duration of combined gastrostomy feeding and chronic dialysi s was 14.5 months (range 2.4-56 months). In 20 of the children followe d for 6 months on combined GB feeding and dialysis, the mean protein a nd energy intakes were 2.5 g/kg bodyweight/day (range 1.7-3.4g) and 10 8 kcal/kg bodyweight/day (range 72-129 kcal). The mean energy intake a chieved was 116% (range 98-155%) of the estimated average requirement (EAR) for energy. The mean percentage of total energy and protein inta kes delivered via the GB during the study period was 61% (33-95%) and 61% (23-98%) respectively. Mean height standard deviation score (SDS) was -2.22 prior to GB feeding and -2.06 at the end of the study period (P=0.005) and mean weight SDS was -2.22 and -1.16 (P=0.001) respectiv ely. The mean life of the GB was 7.7 months (range 2.6-14 months) with most button changes due to leakage problems. Two episodes of peritoni tis were attributable to the GB with one requiring peritoneal dialysis catheter removal due to candida infection. The GB was removed at a me an of 2.8 months (range 0.8-8.3 months) after renal transplantation in 13 children. Conclusion. The gastrostomy button provides a valuable a nd aesthetically appealing route for nutritional support with few comp lications.