Transcript Amino Acid Dialysate in Children on APD

Combined Amino Acid and Glucose
Dialysate in Children on Automated
Peritoneal Dialysis (APD)
1-Jameela Kari , CABP, MD, CCST, FRCPCH, FRCP
Professor of paediatrics and consultant paediatric nephrologist
2-Sharif El-Desoky,MB.CH.B.MPhil
3- Al-Anoud Abuduhair (dialysis nurse)
King AdulAziz University Hospital, Jeddah, Saudi Arabia
(April 2009)
INTRODUCTION
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CRF presenting in childhood may have a
long-standing adverse effect on growth.
Early introduction of enteral feeding may
result in normal growth if it maintained an
adequate energy intake .
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Kari et al, KI 2000, 57: 1681-7
Recently, the use of amino acid (AA)
containing dialysate is considered in
malnourished children .
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Schroder CH, Perit.Dial.Int 2001. 21: 568-74.
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AA dialysis is an efficient form of
peritoneal dialysis in patients on APD and
should be considered for children with
poor nutritional status for whom enteral
nutrition supplementation has been
unsuccessful .
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
Qamar et al,1999, Perit.Dial.Int. 19: 237-47.
It was shown to increase the linear growth
velocity in 5 years old child on APD.
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Brem et al, 1996, Perit.Dial.Int. 16: 634-6.
AIM
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To see if the use of AA dialysate will
improve nutritional markers and
growth in children receiving
automated peritoneal dialysis in a
prospective study
Patients
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All children on APD were recruited for
the study.
Syndromatic and children on growth
hormone were excluded.
Seven children fulfilled the criteria (5
girls & 2 boys).
Their mean age was 11.33+ 3.7.
The mean duration on PD before the
study was 15 + 0.8 months.
Methods
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During the study period children
received hourly APD cycles for 10
hours using mixture of AA dialysate
(1.1%) and dextrose solution.
Monitor: HtSDS, BMI, dialysis
efficiency, serum albumin, renal
function tests and acid-base
disturbances.
HtSDS
4
2
0
-2
-4
-6
-8
HtSDS
4
2
0
-2
-4
-6
-8
HtSDS (mean)
0
-0.5
-1
-1.5
-2
-2.5
-3
-3.5
0
3
71
72
6
73
9
4
5
12
3
5
BMI
17
16
15
14
13
12
11
10
01
32
63
94
125
Serum Albumin
35
30
25
20
15
10
1
0
3
2
3
6
9
4
5
12
Peritonitis
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 WBCs in the peritoneal dialysis fluid (PDF)
>100 cells/ml3, in 5 children (71%), mainly
monocytes.
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Not associated with clinical picture of peritonitis
or elevation CRP or blood WBC count.
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All the cultures were negative for both bacteria
and fungus.
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All of them were treated with intra-peritoneal (IP)
antibiotics with no improvement in the PDF cell
counts.
Catheter Removed
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Two children who were shifted
temporarily to hemodialysis
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PDF: 277 (Mon 22%, N 75%)(3 weeks)
1750 (Mon 40%, N 20%) catheter
removed
PDF: 350 (Mon 42% , N 50%)(4
weeks)1215 (Mon 57% ,N41%) 
catheter removed
A.A Dialysate stopped in two
children
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PDF cell count: 15850 (33%Moncyte and 22%
N) No response to IP antibiotics for 3 weeks.
The A.A Solution stopped and the WBCs dropped
to 62 (26% Monocytes, 57% Eos and 7%N) after
10 days and stayed low.
PDF cell count: 15850 (33%Moncyte and 22%
N) No response to IP antibiotics for 3 weeks.
The A.A Solution stopped and the WBCs dropped
to 46 (86% Monocytes, and 3%N) after 1 week.
Three children completed the study
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One child had a transit  in PDF to
311(72% Mon &22%N), which improved
spontaneously while on AA solution and
completed the 12 months
One child had increase of WBC twice to 86
(70% Mon& 11N) and 55 (78% Mon&
15%N),but not more and completed her
study.
One child had PDF of 0-2 throughout the
study.
Acidosis
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The mean serum HCO3 at the start
of the study was 25.8 + 3.1 on no
NaHCO3 treatment.
All studied children needed oral
NaHCO3 to compensate for the
metabolic acidosis during the study
duration.
NaHCO3 was not required after
stopping the AA dialysate.
Dialysis Efficiency
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There was no difference in peritoneal
equilibration test (PET) before the
study and after finishing the study
Mean Kt/V before the study was
2.04+0.33 and after the study was
1.7+0.78, P=0.32.
Conclusion
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No improvement on nutritional status or
growth parameters in treated children
over 12 months duration.
A.A diaylsate caused sterile peritonitis in
children on APD which improved after
stopping it in two children and
spontaneously in the third child.
The efficiency of dialysis was the same
before and after using the A.A solution.
Acknowledgement
 We thank Baxter
company for sponsoring
our study.
Thank You
[email protected]
[email protected]
King AbdulAziz University Hospital, Jeddah