Oral vitamin intake in children receiving long-term dialysis

Abstract

Objective: To evaluate dietary and oral supplement vitamin intake in children submitted to dialysis (peritoneal dialysis and hemodialysis).

Design: Prospective clinical trial in a 12-month follow-up period.

Setting: Children with end-stage renal disease (ESRD) who attended the pediatric nephrology clinic of Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil.

Patients: Thirty children (18 girls, 23 in peritoneal dialysis, 7 in hemodialysis) with age 9.3 ± 7.4 years.

Intervention methodology: Six successive assessments of both anthropometric indexes and 3-day dietary diaries in children receiving a daily dose of oral water-soluble vitamin supplement.

Main outcome measures: Anthropometric indexes (weight/age [$\text{W}\text{A}$], height/age [$\text{H}\text{A}$], midarm muscle area/age [$\text{MAMA}\text{A}$], and fat area/age [$\text{FA}\text{A}$]) and dietary adequacy-% recommended dietary allowance (RDA) (computerized nutritional analysis from 3-day dietary intake diary).

Results: Anthropometric indexes analysis showed that 53% of children were <−2.0 standard deviation score (SDS) of $\text{W}\text{A}$, 63% were <−2.0 SDS of $\text{H}\text{A}$, and 43.3% were <−1.65 SDS of $\text{MAMA}\text{A}$, suggesting growth deficit and low muscle wasted. Total caloric intake was lower than 100% of RDA in 90% of children. Dietary intake of water-soluble vitamins was <100% of RDA in the majority of children, as follows: vitamin C ($\text{24}\text{30}$), B1 ($\text{28}\text{30}$), B2 ($\text{22}\text{30}$), B3 ($\text{27}\text{30}$), B6 ($\text{26}\text{30}$), B12 ($\text{1}\text{30}$), pantothenic acid ($\text{24}\text{30}$), and folic acid ($\text{9}\text{30}$). The combined dietary and vitamin supplement intake resulted in excessive oral intake for almost all the vitamins.

Conclusion: Dietary intake of water-soluble vitamins is lower than the RDA in the majority of children with ESRD; supplementation is necessary to reach the RDA. The use of the available vitamin supplement resulted in vitamin intakes that exceeded the RDA for almost all of the vitamins. However, we do not know if these intakes exceeded the children's requirements, nor whether they had any clinically significant harmful effects.