Proceedings of the ISPD 2001 — The IXth Congress of the ISPD June 26 – 29, 2001, Montréal, Canada Peritoneal Dialysis International, Vol. 21 (2001), Supplement 3 0896-8608/01 $3.00 + .00 Copyright © 2001 International Society for Peritoneal Dialysis Printed in Canada. All rights reserved. S192 I n June 2000, the National Kidney Foundation (NKF) Dialysis Outcomes Quality Initiative (DOQI) published, in the American Journal of Kidney Dis- eases, 10 guidelines for managing the nutrition of pediatric dialysis patients (1). The DOQI has also provided 27 clinical practice guidelines for adults. The adult guidelines focus primarily on patients under- going maintenance dialysis therapy, although several clinical practice guidelines address nutrition issues for patients with advanced chronic renal failure (CRF) not undergoing dialysis therapy. The pediatric guide- lines focus entirely on children undergoing mainte- nance dialysis treatment. Those guidelines have been formulated through a vigorous process with several reviews (2), and a critical review is difficult. We are delighted to have the guidelines, and any attempted review can target only general questions. GROWTH PARAMETERS TO BE MEASURED Assessment of the nutrition status of children is the starting point for determining the efficacy of implementing the dietary guidelines. Growth failure remains the major concern in children with chronic renal failure. The guidelines suggest measuring these parameters: recumbent length, height, weight, head circumference, mid-arm circumference (MAC), and skin-fold thickness. All of these data are to be consid- ered with regard to reference data based on chrono- logical age. But, especially in pre-term infants, gestational age may be more appropriate. Assessment of body composition is notoriously dif- ficult (3). The DOQI guidelines were derived through a complicated process that involved several steps, including a questionnaire to identify suitable mea- surements for assessing nutrition status. Bioimpedance was included in the initial question- naire, but it was not included in the assessment (3–5). Yet one of the striking features of patient assessment in pediatric nephrology is the scarcity of objective measures to assess dry weight. Bioelectric impedance analysis (BIA) and inferior vena cava diameter (4,6–8) have not been very suc- cessful in the past, because it was not recognized that body surface area is a better reference parameter than chronological age or height (4). When performed un- der controlled conditions, BIA promises to be a useful tool for the optimization of dry weight in pediatric patients (9,10). The usefulness of body mass index and upper-arm muscle area measurements should not be overesti- mated. In an unpublished study on 28 pediatric chronic renal failure patients and patients after suc- cessful transplantation, the upper-arm muscle area and BMI measurements were actually normal, but grip strength was diminished (Figure 1). KEY WORDS: Children; nutrition; height; dry weight; vitamin and mineral requirements; growth hormone. Correspondence to: G. Filler, Division of Pediatric Nephrology, Department of Pediatrics, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada. filler@cheo.on.ca THE DOQI PEDIATRIC NUTRITIONAL GUIDELINES—CRITICAL REMARKS Guido Filler Department of Pediatrics, Division of Nephrology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada Figure 1 — Anthropometric measurements in 28 pediatric patients with chronic renal failure, on dialysis, and after renal transplantation. Data given as mean ± standard deviation. 1 = weight; 2 = body mass index (BMI); 3 = upper- arm fat area; 4= upper-arm muscle area; 5 = grip strength, left arm; 6 = grip strength, right arm; CRF = chronic renal failure on dialysis; KTx = kidney transplantation. by on May 24, 2011 www.pdiconnect.com Downloaded from