Taste perception of children with chronic renal failure

Taste sensitivity and preference in the suprathreshold ranges were compared for 20 pediatric patients with renal disease and 15 children with normal renal function. Nine patients had chronic renal insufficiency, and 11 had endstage renal disease. Subjects were also evaluated for various dietary, anthropometric, and biochemical parameters. All subjects were asked to pull out a tape measure to rate the strength of five varying concentrations of aqueous solutions of sucrose, sodium chloride, and quinine sulfate. The subjects' abilities to judge increasing concentrations with greater perceived intensity were measured by calculating individual and group slopes. No significant differences in the values were found between the groups. Similarly, no significant differences in mean peak preference concentrations were found between the groups. The patients with renal disease were found to be considerably growth retarded (height and weight less than 5th percentile), with a mean caloric intake less than 65% of the RDA even after an adjustment had been made for height. Serum zinc levels were all normal.     

Comparison of two micronutrient supplements in children with chronic renal failure.

OBJECTIVE: To compare a newly formulated renal-specific micronutrient (RSM) supplement (vitamins C, E, K, and B complex, copper, zinc) with Ketovite (Paines & Byrnes, Middlesex, UK) tablets (vitamins C, E, K, and B complex) in children with chronic renal failure (glomerular filtration rate [GFR] < 25 mL/min/1.73 m(2)) or on chronic peritoneal dialysis (CPD) and hemodialysis (HD). DESIGN: Children currently prescribed Ketovite tablets were changed to RSM for 3 months. Questionnaires on palatability, acceptability, and ease of administration were assessed while on Ketovite and after 3 months on RSM along with plasma levels of zinc, copper, folate (serum, red cell), vitamin B(12), and homocysteine. SETTING: Regional pediatric nephrology unit. PATIENTS: Fifteen children (10 male) with a mean age of 10.4 years (range, 1.1 to 16 y) were recruited (11 had GFR < 25 mL/min/1.73 m(2), 2 CPD, 2 HD). Two children received overnight gastrostomy button feeding. Main Outcome Measures: Fourteen children (1 child refused RSM after 1 week) and their families completed questionnaires using a Likert scale: 1 (liked) to 7 (disliked). Plasma levels were analyzed at baseline on Ketovite and after 3 months on RSM. RESULTS: Children disliked the smell of Ketovite compared with RSM (P =.004). The size of Ketovite was preferable to the size of the RSM (P =.015) and was believed to be easier to administer (P =.046). There were no differences in patient/parent rating of appearance, texture, or taste, but 8 of 15 patients (53%) expressed a preference for the RSM if available. Plasma values of copper, zinc, folate, and vitamin B(12) were within the normal reference range on Ketovite and showed no significant change on RSM. Mean plasma homocysteine levels were above normal reference ranges in all groups (GFR < 25 mL/min/1.73 m(2), 7.6 [SD, 3.1]; CPD, 11.5 [SD, 1.6]; HD, 12 [SD, 8.7]) on Ketovite and were unchanged after 3 months on RSM. CONCLUSIONS: This pilot study confirms the acceptability of the RSM, particularly in relation to its smell and chewability, but the current size may preclude its widespread use. The incorporation of zinc and copper will be beneficial for many children, but reduction in homocysteine levels may necessitate an increase in folic acid content.     

Factors affecting the nutritional status of patients with chronic renal failure undergoing haemodialysis

There is a high prevalence of the features of protein-energy malnutrition among patients with chronic renal failure undergoing maintenance haemodialysis. Poor food intakes are only partly responsible. The disease state itself and renal replacement therapy are contributing factors to the development of malnutrition. Hypogeusia, anorexia and impaired digestion of nutrients have been reported. Changes in the hormonal environment may result in poor utilization and altered metabolism of nutrients. The requirements for nutrients may be different to those in normal healthy individuals. However, despite the effects of unalterable non-dietary factors on nutrition, it is possible to manipulate dietary intakes to improve the nutritional status.     

Effect of the correction of metabolic acidosis on nutritional status in elderly patients with chronic renal failure.

BACKGROUND: Metabolic acidosis (MA) is a frequent complication in advanced chronic renal failure (CRF). Currently, there is good evidence that MA contributes to malnutrition in CRF patients. METHODS: We evaluated the effect of correcting MA on nutritional status after 6 months of oral sodium bicarbonate supplementation in 18 patients aged 73 +/- 6 years with CRF to maintain serum bicarbonate levels at 24 +/- 2 mmol/L. The following parameters were measured: dietary record, energy intake, dietary protein intake (DPI), mini-nutritional assessment (MNA), serum albumin level, prealbumin level, prognosis inflammatory and nutritional index (PINI), and protein catabolic rate (nPCR). RESULTS: No significant changes in body weight or systolic and diastolic blood pressure were observed. Serum albumin and prealbumin levels showed a significant increase. nPCR decreased significantly. DPI, energy intake, PINI, and MNA score did not change significantly. No patient reported side effects or fluid retention during the study. CONCLUSION: Correction of MA improves serum albumin and prealbumin concentration, and it is not associated with any significant change in DPI, but induces a decrease in nPCR values. Whereas nPCR may provide an index of protein catabolism, it does not differentiate between dietary sources of protein or net catabolism of endogenous proteins. In the absence of dietary changes, the decrease in nPCR values may be attributed to a decrease in whole body protein degradation.     

老年慢性肾功能不全患者的营养状况评价

目的应用微型营养评定(MNA)方法来评价住院老年慢性肾功能不全病人的营养状况.方法110例住院老年慢性肾功能不全患者,采用微型营养评定(MNA)问卷调查法进行营养评定,同时结合人体测量、生化检查.结果[1]根据MNA评分营养不良者28例(25.5%);营养不良危险者56例(50.9%);营养良好者26例(23.6%).[2]轻度、中度、重度肾功能损害三组的营养不良及营养不良危险者发生率分别为70.9%、79.0%、100.0%.[3]MNA评价的营养状况结果有效的反映人体测量、生化检查.结论[1]住院老年慢性肾功能不全病人的营养不良发生率较高.[2]微型营养评定(MNA)方法应用在住院老年慢性肾功能不全病人的营养状况评价中是可行的.     

Ionized calcium in patients with chronic renal failure.

Parameters of various renal disorders were studied in 31 patients (17 men and 14 women) who all were in the stage of chronic renal failure (CRF). These parameters included total serum creatinine, ionized calcium, serum creatinine, creatinine clearance and acid-base balance. The results were compared with a control group of 30 healthy subjects. In the patients with first stage CRF, the total serum calcium did not significantly decrease (mean = 2.19 +/- 0.12 mmol/l) and ionized calcium was within reference value limits (mean = 1.28 +/- 0.02 mmol/l). The percentage of ionized calcium in total serum calcium was higher for these patients (mean = 58.43%) than for the control group (mean = 52.25%). For patients with first and second stage CRF, the total serum was significantly lower (mean = 1.92 +/- 0.03 mmol/l) than for the healthy controls (p < 0.001) as well as for patients with first stage CRF (p < 0.05). The ionized calcium in these patients was not significantly lower (mean = 1.14 +/- 0.01 mmol/l); however, its percentage was higher than that of serum calcium (mean = 59.38%). There was a slight negative correlation between the levels of ionized calcium and serum creatinine in patients with first stage CRF (r = -0.30) and a significant correlation in patients with second and third stage CRF.     

Gastric bypass in chronic renal failure and renal transplant.

BACKGROUND: Morbid obesity has reached epidemic proportions in developed nations worldwide, causing considerable mortality and increased healthcare expenditures. The use of gastric bypass surgery to achieve weight loss in morbidly obese patients with chronic renal failure (CRF) and postrenal transplant patients has not been studied adequately. METHODS: Forty-one patients with different stages of CRF (25 already receiving dialysis) underwent a gastric bypass (GBP), and an additional 10 patients underwent a GBP after becoming morbidly obese after transplantation. RESULTS: Of the 41 patients with CRF, 5 stabilized or resolved their kidney disease and 9 underwent successful transplantation. These patients had a loss of 68% excess body mass index (BMI) by 12 months after GBP. Of the 10 patients with GBP after transplant, the mean loss of excess BMI was 70.5%. There were no in-hospital or 30-day mortalities, but 8 of the 51 patients died from 112 to 2869 days postoperatively, 7 from cardiac or vascular events and 1 from an automobile accident. This compares with an approximate 10% mortality per year for patients receiving dialysis. Comorbid conditions associated with morbid obesity improved in all patients and permitted eligibility for transplantation. CONCLUSIONS: GBP for massive weight reduction in morbidly obese renal failure and transplant patients leads to a reduction in comorbid conditions that are associated with an increased risk for cardiovascular deaths. There was no operative mortality in this series, and all but 1 death were related to previously existing disease of the cardiovascular system.     

Living with chronic renal failure

We describe our impressions gained in the process of systematic interviewing of children with chronic renal failure. In spite of improved techniques of medical treatment in recent years, many of these children and their families remain under considerable strain. This is caused by anxieties about the child's general prospects for the future, problems in accepting the illness and treatment, particularly with a late onset of the condition, and multiple hospital admissions with occasional life-threatening incidents. In spite of their less serious nature, chronic features such as poor growth and urinary incontinence seem to be particularly worrying for many children and their parents. We feel that it is worth considering how to improve the supports for these families, helping parents to be more aware of community facilities that are available, and striving to improve communication between the different agencies (hospital, general practitioners, schools, etc.) involved.     

Skeletal muscle function in chronic renal failure: an index of nutritional status

To determine whether skeletal muscle function testing (SMF) provides an index of nutritional status in patients with chronic renal failure (CRF), two groups with comparable CRF were studied. In 48 well-nourished (WN) and 17 malnourished (MN) patients with stable CRF, and in 33 WN nonazotemic controls, adductor pollicis function was assessed. The force at 10 Hz was expressed as a % of force at 100 Hz (F10/F100), and maximal relaxation rate (MRR) as % force loss/10 ms. Standard nutritional assessment was also performed. The WN group was not significantly different from controls for either F10/F100 or MRR. The F10/F100 of the MN group was significantly greater than either the WN group or controls (p less than 0.001), while MRR was less (p less than 0.001). Significant malnutrition by conventional parameters was shown in patients with abnormal F10/F100, and also in patients with abnormal MRR. Hence, SMF as described is unaffected by azotemia, and provides a functional measure of nutritional status in CRF.     

Immunologic evaluation in the nutritional assessment of children with cancer

Eighty-one newly diagnosed untreated pediatric cancer patients (48 hematopoeitic malignancies, 17 solid tumors, 16 benign diseases) were evaluated with immunologic and nutritional parameters. The mean absolute lymphocyte count was adequate in the three groups. Reduced T-lymphocytes were seen in the solid tumors. Mitogenic response of hematopoietic and solid tumor patients' lymphocytes was low. Correlation of immunologic, dietary, and nutritional factors showed that for patients with solid tumors there was a positive significant correlation between weight/height percent and lymphocyte reactivity to phytohemagglutinin, concanavalin A, and pokeweed mitogen (p less than .05). Iron intake showed a significant positive correlation with in vitro mitogen reactivity for the solid tumor group (p less than .05) and benign diseases (p less than 0.01). Immune derangements found among patients with hematopoietic malignancies can be due to replacement of normal bone marrow with malignant cells. In solid tumor patients mitogen reactivity appears to be a reflection of nutritional state, and dietary iron is a possible factor.     

Captopril for refractory hypertension in patients with chronic renal failure and renal transplantation.

The converting-enzyme inhibitor, captopril, was given to ten patients with refractory severe hypertension of renal origin: 6 patients had chronic renal failure, 3 patients had hypertension following renal transplantation, and one patient had hypertension and congestive cardiac failure. Control of blood pressure was achieved with doses from 78 to 400 mg/day. Severe hyperkalaemia occurred in one patients, ageusia (dose dependent) in another, and one patients withdrew from treatment because of nausea.     

Energy balance in children and young adultsreceiving haernodialysis for chronic renal failure

This study was designed to determine the contribution of energy expenditure tothe energy imbalance seen in uraemic children. Resting energy expenditure (REE) was measured using open-circuit indirect calorimetry in eight uraemic haemodialysed subjects aged 9.3–20.4 years and in 10 healthy children. Linear correlations between REE and both body weight and fat-free mass as measured by anthropometry were found in both controls and uraemic subjects (respectively: r = 0.76 and r = 0.88 for body weight and r = 0.73 and r = 0.90 for fat-free mass). Measured REE in uraemic patients was not different from the value predicted by using actual body weight and fat-free mass in the regression equation of REE on body weight and fat-free mass in controls (paired t test: p = 0.70 and p = 0.19 respectively). These data suggest that the energy imbalance seen in uraemic children is not due to increased energy expenditure and is therefore probably due to decreased food intake.     

小儿慢性肾衰竭网织红细胞参数的变化

目的了解小儿慢性肾衰竭(CRF)的病因构成、临床特点及其网织红细胞(Ret)参数的变化。方法收集2009年1月~2010年12月于我院住院的23例CRF患儿,男16例,年龄最小4个月,最大13岁;女7例,年龄最小9个月,最大15岁。对其病因、临床特点进行回顾性分析;用LH750血细胞分析仪检测肾性贫血患儿和正常儿童网织红细胞参数的变化。结果获得性肾小球疾病13例(55%),平均发病年龄12.25岁,确诊前病程平均1.56 a;先天性肾脏疾病10例(45%),平均发病年龄8.46岁,确诊前病程平均4.39 a。CRF主要临床表现为肾性贫血、高血压、电解质紊乱、代谢性酸中毒、生长发育迟缓和感染等等。经检测,肾性贫血患儿的网织红细胞百分比(Ret%)较正常组升高,但网织红细胞不成熟度(IRF)值基本正常或略低。结论我院小儿慢性肾衰竭病因主要以获得性肾小球疾病为主,对其网织红细胞各参数的检测,有利于了解肾性贫血患儿的骨髓增生程度和红系生长情况,为临床正确评估肾脏功能、及时用药提供参考价值。     

Resting metabolic rate in chronic renal failure.

OBJECTIVE: A decrease in resting metabolic rate (RMR) in patients with chronic renal failure was assumed to occur because of the decreasing oxygen consumption of the kidneys, which in healthy subjects, accounts for 7.2% of RMR. Contrary to this assumption, RMR per body weight in end-stage renal disease was increased. DESIGN AND METHODS: To test the impact of chronic renal failure on the RMR, direct bedside calorimetry was performed on 51 outpatients (age, 53.2 +/- 13.9 y; creatinine clearance, 6.9 to 52 mL/min). Twenty two of 51 patients were examined repeatedly (at the start of the study, after 3 months, and after 6 months) during declining kidney function. RESULTS: In the total group, RMR per body weight (RMR/BW) was 100.0 +/- 4.96 kJ/kg/day and RMR per body surface area (RMR/BSA) was 4.582 +/- 0.181 kJ/min/1.73m(2). RMR/BW and RMR/BSA correlated significantly with creatinine clearance (n = 51, r = -.763, P <.001; n = 51, r = -.557, P <.001). In the follow-up group, creatinine clearance decreased from 27.5 +/- 9.5 mL/min initially, to 19.4 +/- 6.25 mL/min at 3 months, to 13.0 +/- 3.8 mL/min at 6 months (P <.001), while RMR/BW and RMR/BSA increased from 98.28 +/- 6.3, to 101.64 +/- 5.46, to 105.42 +/- 6.3 kJ/kg BW/d (P <.005), respectively, and 4.41 +/- 0.126, to 4.578 +/- 0.168, to 4.704 +/- 0.168 kJ/min/1.73 m(2) (P <.05), respectively. CONCLUSION: Taking into account the reduced oxygen consumption of the shrinking kidneys, the normal RMR suggests an increased energy expenditure per body cell mass. The raising RMR in deteriorating excretory kidney function reflects the increasing energy expenditure in progressive chronic renal failure.