South Andrew M, Fainman Bonnie, Sutherland Scott M, Wong Cynthia J
Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
J Ren Care. 2018 Mar;44(1):38-43. doi: 10.1111/jorc.12226. Epub 2017 Dec 12.
People undergoing haemodialysis (HD) often have poor nutrition, which in turn can contribute to worse outcomes. Inadequate nutrition has a particularly deleterious effect on growth and neurocognitive development, as well as mortality, in children and adolescents. Nutritional supplementation can improve outcomes but can be difficult to administer.
Determine the tolerability of intradialytic oral nutrition in children and adolescents.
A cross-sectional quality improvement study in an outpatient paediatric HD unit. Intervention was intradialytic oral nutritional supplementation provided as protein bars and/or meals.
Children and adolescents undergoing outpatient HD who were able to participate in surveys and eat by mouth.
Adverse effects and symptoms on nurse- and patient-reported surveys, respectively. Relationships between the predictor variables and the outcomes were assessed using generalised estimating equations.
The majority of children felt better after eating on dialysis (72%) with no adverse effects (80%). On unadjusted analyses and confirmed with generalised estimating equation modelling, children who reported being hungry felt better after eating on dialysis, despite being more likely to have adverse effects.
The study demonstrates that our children and adolescents feel better after eating on HD with minimal adverse effects. The finding that hungry patients are more likely to feel better despite having a higher likelihood of an adverse effect demonstrates the tolerability of eating on HD. Intradialytic oral nutrition could be a safe and well-tolerated opportunity to provide supplemental nutrition to paediatric HD patients and improve outcomes.
接受血液透析（HD）的患者往往营养状况不佳，这反过来又会导致更差的治疗结果。营养不足对儿童和青少年的生长发育、神经认知发展以及死亡率有着特别有害的影响。营养补充剂可以改善治疗结果，但给药可能会很困难。
确定儿童和青少年在透析期间口服营养的耐受性。
在一家儿科门诊血液透析单元进行的横断面质量改进研究。干预措施为在透析期间提供蛋白质棒和/或餐食形式的口服营养补充剂。
能够参与调查并经口进食的门诊血液透析儿童和青少年。
分别通过护士和患者报告的调查评估不良反应和症状。使用广义估计方程评估预测变量与结果之间的关系。
大多数儿童在透析期间进食后感觉更好（72%），且无不良反应（80%）。在未经调整的分析以及通过广义估计方程模型确认后发现，报告饥饿的儿童在透析期间进食后感觉更好，尽管他们更有可能出现不良反应。
该研究表明，我们的儿童和青少年在血液透析期间进食后感觉更好，且不良反应最小。饥饿患者尽管出现不良反应的可能性较高，但更有可能感觉更好这一发现表明了在血液透析期间进食的耐受性。透析期间口服营养可能是为儿科血液透析患者提供补充营养并改善治疗结果的一种安全且耐受性良好的方式。
