The Relationship between Nutritional and Biochemical Markers with Growth Parameters in Adolescents with Chronic Kidney Disease on Maintenance Dialysis

Abstract

Background: Adolescents with chronic kidney disease (CKD) undergoing maintenance dialysis often experience challenges related to nutritional and biochemical markers, which can impact their growth parameters. Understanding the association between these markers and growth outcomes is crucial for optimizing the management of CKD in this population. Objectives of the study: The objective of this study is to investigate the relationship between nutritional and biochemical markers and growth parameters in adolescents with CKD undergoing maintenance dialysis in a cross-sectional single-center setting. Methodology: Participants recruited for this study were children aged 12–18 years diagnosed with CKD 5 undergoing maintenance dialysis. The assessed nutritional and biochemical markers included dry weight, body mass index (BMI), caloric and protein intake, normalized protein catabolic rate (nPCR), total body fat percentage, muscle mass, serum albumin, blood urea nitrogen, serum creatinine, and C-reactive protein. Results: Twenty-six children were enrolled in the study (male: female – 1:1.6). Thirteen participants were from each treatment group (peritoneal dialysis and hemodialysis). Among them, twenty (76.9%) exhibited stunting, defined as a height percentile below the third percentile for the group’s population. Notably, patients with stunting showed a significant decrease in dry weight (37.4 kg vs. 54.7 kg, P < 0.01) and BMI (17.3 kg/m2 vs. 22.3 kg/m2, P = 0.03). Serum creatinine levels were notably lower among patients with stunting compared to those with normal height percentiles (728 μmol/L vs. 969 μmol/L, P < 0.01). Using bioelectrical impedance, muscle mass was noted to be significantly reduced in those with stunting compared to children with normal growth. Furthermore, a significant association was observed between nPCR and protein intake (P = 0.010). Conclusion and Recommendation: This study reveals a high prevalence of stunting in pediatric CKD patients on maintenance dialysis, suggesting compromised nutritional status. CKD patients with stunting exhibit reduced muscle mass and lower serum creatinine levels. Additionally, nPCR appears to be a useful marker for assessing protein adequacy. These findings highlight the need for early and regular monitoring of growth parameters, comprehensive biochemical assessments, and further research to enhance outcomes in pediatric CKD patients.