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Two-point normalized protein catabolic rate overestimates nPCR in pediatric hemodialysis patients

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Abstract

Background

Normalized protein catabolic rate (nPCR) calculation depends on estimating the urea generation between consecutive hemodialysis (HD) treatments. Two-point nPCR using blood urea nitrogen (BUN) before and after the same HD treatment has not been validated in pediatric patients, who typically receive a more intense HD dose than adults. This study aimed to compare nPCR calculated with a two-point vs. a three-point nPCR model in pediatric HD patients.

Methods

Pediatric patients receiving HD at 2 units were enrolled. Three BUN measurements were obtained around a midweek HD treatment: one prior to HD (preBUN1), one 30 s after HD (30sBUN), and one prior to the subsequent HD (preBUN2). The two-point nPCR model was calculated using preBUN1 and 30sBUN and the three-point nPCR model was calculated using preBUN2 and 30sBUN.

Results

Seventy-six BUN sets from 35 patients were analyzed. Mean age was 16.4 ± 3.5 years. Mean dry weight was 51.4 ± 17.1 kg. Mean spKt/V was 1.54 ± 0.23. Mean preBUN2 was significantly lower than mean preBUN1 (60.2 ± 18.6 vs. 64.0 ± 18.9 mg/dl, p = 0.0001). nPCR obtained from the three-point model was significantly lower than nPCR obtained from the two-point model (1.07 ± 0.31 vs. 1.17 ± 0.31 g/kg/day, p = 0.00001). Seven of 76 (9.2 %) paired comparisons yielded three-point nPCR <1 vs. two-point nPCR >1.

Conclusions

Our data show that in pediatric patients receiving HD, the ((1) two-point and three-point models lead to significantly different nPCRs, and (2) inaccurate protein intake assessment may result from reliance on a two-point model for nPCR estimates.

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Authors and Affiliations

  1. Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, 77030, USA

    Poyyapakkam R. Srivaths

  2. Pediatric Nephrology, Stanford University Medical Center, Stanford, CA, 94305, USA

    Scott Sutherland & Steven Alexander

  3. Pediatric Nephrology, Cincinnati Children’s Hospital, Cincinnati, OH, 45229, USA

    Stuart L. Goldstein

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  1. Poyyapakkam R. Srivaths
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  2. Scott Sutherland
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  3. Steven Alexander
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  4. Stuart L. Goldstein
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Correspondence to Poyyapakkam R. Srivaths.

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Srivaths, P.R., Sutherland, S., Alexander, S. et al. Two-point normalized protein catabolic rate overestimates nPCR in pediatric hemodialysis patients. Pediatr Nephrol 28, 797–801 (2013). https://doi.org/10.1007/s00467-012-2371-x

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  • DOI: https://doi.org/10.1007/s00467-012-2371-x

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