Nephrology Dialysis Transplantation, Vol 13, Issue 6 1484-1488, Copyright © 1998 by Oxford University Press
N Besbas, S Ozdemir, & Saatci, T Coskun, S Ozen, R Topaloglu, A Bakkaloglu and A El Nahas
Background: Protein-energy malnutrition (PEM) is
associated with increased morbidity and mortality in haemodialysis (HD)
patients. Insulin-like growth factor I (IGF-I) has proved to be a sensitive
marker of malnutrition, while interleukin-1 (IL-1{beta}) and tumour
necrosis factor (TNF) have been found to be raised in catabolic states.
Methods: We have investigated the nutritional status
of 17 chronic renal failure (CRF) paediatric patients (8 boys, 9 girls) on
maintenance HD. Eight predialysis CRF children (5 boys and 3 girls; mean
creatinine 5.1±3.2 mg/dl) and 10 healthy children served as
control groups. PEM was defined according to anthropometric measurements
(triceps skinfold thickness (TST), mid-arm circumference (MAC), and mid-arm
muscle circumference (MAMC). These were correlated with serum IGF-I, IL-1
TNF-&agr; transferrin, and albumin (all sampled before the HD session).
Results: In the HD group, TST was reduced in 41.2% of
the patients, whereas MAC and MAMC were reduced in 82.4 and 76.5%
respectively. TST was depleted in only one of the predialysis CRF children.
The degree of reduction in MAC and MAMC were 62.5 and 62.5% respectively.
Median serum IGF-I level was decreased in both HD and predialysis CRF
patients (205.1 interquartile range (IQR) 194.4 &mgr;g/l and 258.8 IQR
155.0 &mgr;g/l respectively) compared to the healthy children (418.0
IQR 310.5&mgr;g/l) (P=0.0009 and P=0.01 respectively). Within the HD
group, IGF-I levels were lower in patients with malnutrition defined
according to TST (145.0 IQR 125.5 &mgr;g/l) compared to children with
normal TST (201.2 IQR 218.8 &mgr;g.l) (P=0.05). IGF-I levels of the HD
patients with malnutrition according to TST was also lower than predialysis
CRF patients and healthy children (P=0.04 and P=0.002 respectively). Serum
IL-1{beta} was undetectable in all groups. Median serum TNF-&agr;
levels were higher in HD and predialysis CRF patients compared to healthy
children, albeit statistically insignificant. There was no correlation
between TNF-&agr;, transferrin or albumin and anthropometric
parameters. Conclusions: Our results support the high
prevalence of malnutrition in CRF children, which becomes more pronounced
when treatment by HD is initiated. We suggest that determination of IGF-I
levels in childhood HD patients in conjunction with anthropometric
measurements is useful for identification of malnutrition. We have not been
able to demonstrate the catabolic effects of cytokines on this state of
protein-energy malnutrition. Key words: children;
chronic renal failure; cytokines; insulin-like growth factor-I; nutrition
ORIGINAL ARTICLES
Nutritional assessment of children on haemodialysis: value of IGF-I, TNF-&agr; and IL-1{beta}
Departments of Pediatric Nephrology and Rheumatology and Nutrition and Metabolism, Hacettepe University Medical Faculty, 06100 Sihhiye, Ankara, Turkey; Sheffield Kidney Institute, Sheffield, UK; Corresponding author
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