Initial hypoalbuminemia and hyperlipidemia persist during chronic peritoneal dialysis in children

Abstract

Objective: To document serum lipid values in pediatric peritoneal dialysis (PD) patients, particularly the very young, and investigate relationships with serum albumin levels. Design: Retrospective review of all PD patients seen in the first 11 years of the PD program at our institution. Patients and Methods: Any pediatric PD patient was eligible for inclusion if at least four simultaneous measurements of serum lipids and albumin were recorded over a minimum of 90 days of PD. Results: Thirty-nine continuous ambulatory peritoneal dialysis (CAPD) patients (9, aged < 5 years) and 14 continuous cycling peritoneal dialysis (CCPD) patients (7, aged < 5 years) were followed for 90-1200 days. Hypoalbuminemia, present in 43% of initial recordings, did not alter significantly during PD in any group; it was most marked in the CAPD < 5 year (mean 30.7 g/L) and CCPD > 5 year groups (mean 31.4 g/L). Average serum cholesterol levels were 27% higher, and triglyceride 122% higher, than the maximum accepted 18-year-old level and did not change significantly during PD. Similarly, 33% of high-density lipid recordings were below normal and remained unaltered during PD. Conclusions: Our results confirm the high incidence of hypoalbuminemia, hypertriglyceridemia, and hypercholesterolemia and associated low levels of high-density lipids, even in young PD patients, and demonstrate that these remain unchanged during PD. Such results have not previously been reported in PD patients as young as ours. Abnormal lipid profiles are a neglected cardiovascular risk factor in children with renal failure; therapeutic interventions should therefore be seriously considered.