17
CAPD patients (8 girls, 9 boys; mean age 13.1 +/- 3.5 years, median 15 years) were included in the study. Anthropometric measurements and
serum albumin levels were used in the evaluation of nutritional status. Serum
interleukin (IL)-1beta,
IL-6,
tumor necrosis factor alpha, and
IGF-1 levels were determined in all
CAPD patients and in a healthy control group. Weekly Kt/V and
creatinine clearance (CCr) were measured to determine adequacy of dialysis.
RESULTS: The mean dialysis period was 23.7 +/- 15.2 months (median 23 months). Anthropometric measurements and
serum albumin level were as follows: height 130.2 +/- 15.6 cm, height standard deviation score (HtSDS) -4.2 +/- 2.4, body mass index (BMI) 16.3 +/- 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 +/- 0.9, triceps skinfold thickness (TST) 4.2 +/- 1.4 mm, midarm circumference (MAC) 16.21 +/- 2.3 cm, upper arm muscle area (AMA) 1799.1 +/- 535.7 mm2, upper arm fat area (AFA) 334.5 +/- 143 mm2, and
serum albumin 3.1 +/- 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean
serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V (r = 0.69, p < 0.01), CCr (r = 0.64, p < 0.05), and
IL-6 (r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period (r = -0.58, p < 0.05); and between
IL-6 and
serum albumin (r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum
IGF-1 level (r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum
IGF-1 level and both HtSDS (r = 0.57, p < 0.05) and TST (r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and
IGF-1 were also noted (both r = 0.56, p < 0.05).
CONCLUSION: Although many factors may be responsible for
malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low
IGF-1 levels are the most important risk factors in
CAPD patients.