Nutritional effects of increasing dialysis dose by adding an icodextrin daytime dwell to Nocturnal Intermittent Peritoneal Dialysis (NIPD) in children

Background. To assess the need to adapt dietary prescriptions, we studied potential effects of increasing the dialysis dose by adding a daytime icodextrin dwell, in children on Nocturnal Intermittent Peritoneal Dialysis (NIPD), on peritoneal amino acids (AA) and albumin loss, AA, albumin, cholesterol and fibrinogen plasma levels and nutritional intake. Methods. A cross-over study in eight children (age 2-12 years) on NIPD at baseline (week 1). Intervention: to increase dialysis dose we added a daytime dwell with 1100 ml/m² icodextrin solution for a week (week 2). Main outcome measures: peritoneal albumin loss (quantified by nephelometry) and AA loss (quantified by liquid chromatography mass spectrometry) in the last 72 h dialysate collections of weeks 1 and 2. On days 7 and 14, morning blood sample was taken for urea, creatinine, plasma AA levels, serum albumin, cholesterol and fibrinogen determination. Nutritional intake diaries were kept throughout the study period. Results. Weekly dialysis creatinine clearance increased from 35 to 65 1/1.73 m² (P<0.0001) and Kt/V from 1.99 to 2.54 (P<0.01 . Peritoneal albumin loss did not change significantly (2.4±0.4 to 2.4±0.3 g/m²/24 h) nor did serum albumin (3.25±0.52 to 3.21±0.25 g/dl), cholesterol (216±73 to 240±61 mg/dl) and fibrinogen (385±40 to 436±64 mg/dl). There was a significant increase in loss of essential (EAA) [1122±200 to 2104±417 mg/m²/week (P<0.0001)] and non-essential amino acids (NEAA) [6160±1341 to 10406± 2899 mg/m²/week (P<0.001)]. Plasma AA levels did not change significantly except for a drop in histidine and glutamine. Dietary protein intake did not change from 43±12 to 41±8 g/m²/day, caloric intake from 73±21 to 70±24 kcal/kg/day. Conclusions. Increasing dialysis dose by introducing a daytime icodextrin dwell during a week does not affect peritoneal albumin loss, serum albumin, cholesterol and fibrinogen levels nor dietary intake on a short term. There is a significant increase in EAA and NEAA loss without change in plasma levels. We suggest monitoring dietary intake when adding a daytime icodextrin dwell in children.