Provision of dietetic care in children on chronic peritoneal dialysis

Abstract

Objective: To estimate the provision of dietetic care necessary to manage and support children receiving chronic peritoneal dialysis (CPD) with/without nutritional support via a gastrostomy button (GB) and their families. Design: Three-year prospective, longitudinal study documenting dietetic contacts (direct: inpatient/outpatient, telephone, home, school, and family practitioner visits; and indirect: with other health professionals). Setting: Regional Pediatric Renal Unit. Participants: Thirteen children (7 male; 5<5 yrs of age) commenced CPD at a mean age of 7.7 years (range, 0.2 to 8.5 years). Eight children received tube feeding (7 GB, 1 nasogastric [NG]) in combination with CPD at a mean age of 4.3 years (range, 0.2 to 8.2 years). Main outcome measures: Quantitative data regarding dietetic contacts and growth parameters. Results: Seven hundred eighty-one dietetic contacts were recorded during 182 patient months of observation, with a mean of 5.9 (standard deviation [SD] 1.9) contacts per patient, per month in children < 5 years of age, compared with 3.1 (SD 1.6) contacts in children > 5 years of age. Eighty-two percent of contacts were with children receiving nutritional support via a GB. Telephone contact accounted for 41% of all contacts in the less than 5 years of age group, compared with 7% in children greater than 5 years of age. Mean standard deviation scores (SDS) for height and weight at the start of the study were −1.2 and −1.32, and at the end were −1.14 and −0.73. Body mass index (BMI) SDS significantly improved from −0.91 to 0.17 ( P = 0.03). Conclusion: This study illustrates the number and nature of dietetic contacts that we felt were required to support children and families on CPD. Attempts to achieve adequate nutritional intakes for growth require frequent adjustments of nutritional prescriptions, particularly in preschool children.