Growth during maintenance hemodialysis: Impact of enhanced nutrition and clearance

Growth of children during maintenance hemodialysis has been reported to be uniformly poor, with a mean annual loss of 0.4 to 0.8 SD in height. We adop ted an intensive program of closely monitored energy and protein intake wit h dialysis urea clearances exceeding conventional recommendations. Twelve p repubertal or early pubertal children (aged 7 months to 14 years) were moni tored for an average of 2.2 years (range 4 to 81 months) while receiving ma intenance hemodialysis. These children received an average of 90.6% and 155 .9% of their recommended energy and protein nutritional intake, respectivel y. With a prescribed urea clearance of 5 ml/kg/min, we achieved a mean sing le treatment urea clearance normalized for total body water of 2.00, a urea reduction ratio of 84.7%, and an average time of hemodialysis of 14.8 h/wk , all well beyond current guidelines. Over the course of dialysis treatment , the improvement in height SD score was +0.31 SD/y (+0.32 excluding the 2 children treated with recombinant human growth hormone). Normal growth was achieved without overt obesity and was associated with normal pubertal grow th spurt. These findings suggest that the combination of increased dialysis and adequate nutrition can promote normal growth in children treated with long-term hemodialysis.