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P280 LIFE THREATENING SEPSIS DURING HOME PARENTERAL NUTRITION MAY BE AN INDICATION FOR FOSTER CARE
Nutrtion and Chronic Diseases III
143
aiming to evaluate clinical practices in dialysis. Data from more than 9,000 maintenance hemodialysis patients were collected in June 2008 in a cross-sectional manner. Results: Protein intake, derived from protein nitrogen appearance, was satisfactory according to the latest recommendations (nPNA 1.0 g protein/kg/d). However, 58.7% of patients had serum albumin lower than 38 g/l, potentially explained by a chronic inflammation. Indeed, 58.5% of patients had a C-Protein Reactive above 5 mg/l. More than half of the patients had serum phosphate level within the current phosphocalcic target. The use of native vitamin D only reached 30% of patients; the mean 25(OH) serum level was 21.6±20.0 mg/l, corresponding to a deficient state. Table: Patients Age (years), Mean±SD Body Mass Index (kg/m2 ), Mean±SD Protein intake (g/kg/d), Mean±SD S Albumin (g/l), Mean±SD C-reactive protein (mg/l), Mean±SD/Median S phosphorus (mmol/l), Mean±SD
n = 125 67.9±14.6 24.9±5.2 1.13±0.40 36.4±5.1 13.6±26.3/5.9 1.5±0.5
Conclusion: This up-to-date analysis shows that despite adequate protein intake, maintenance hemodialysis patients have a very low serum albumin level, potentially explained by a chronic inflammation. Both factors are strongly linked to mortality. Prospective follow-up of the Photo-Graph cohort will allow to determine whether different treatments affect clinical outcome in dialysis patients. Disclosure of Interest: D. Fouque, Genzyme, Grant Research Support
P280 LIFE THREATENING SEPSIS DURING HOME PARENTERAL NUTRITION MAY BE AN INDICATION FOR FOSTER CARE V. Zamvar1 , G. Lazonby2 , J.W. Puntis1 . 1 Paediatric Gastroenterology, 2 Paediatric Gastroenterology and Nutrition, The General Infirmary at Leeds, Leeds, United Kingdom Rationale: While offering an improved quality of life, home parenteral nutrition (HPN) burdens parents with major responsibilities. Although recurrent life threatening catheter related blood stream infection (CRBSI) is an indication for intestinal transplantation (ITx), it may also reflect unrecognised parental difficulty with management compliance. Aims: to review HPN patients with life threatening CRBSI and assess the impact of change of carers on clinical progress. Methods: Case notes review. Results: Out of 37 children enrolled into an HPN programme, 2 had frequent CRBSI requiring repeated admission to paediatric intensive care (PICU). After assessment, both were recommended for ITx. An 8 m old girl with SBS-complicated gastroschisis was discharged home on PN. Both parents were willing and judged competent to undertake home care. There were complex social issues in the family but there was little input from social services. Over the next 3 years she had 32
episodes of CRBSI with 3 admissions to PICU for cardiorespiratory support. Parents appeared slow at recognising signs of sepsis, did not visit during hospital admissions, and eventually admitted to not being able to cope. Subsequently discharged into foster care, there has been only one episode of CRBSI in 3 years, managed simply with antibiotics. A 3 m old girl with SBS secondary to neonatal volvulus was discharged on HPN. Her single mother was willing and competent to take on this responsibility, and over the first 15 months there were 5 episodes of CRBSI. During the next 15 mo she had 16 episodes of CRBSI with four admissions to PICU. Following discussions with the family and social services, the child went into voluntary foster care with grandparents. Six months later, there have been no further episodes of CRBSI. Conclusion: Life threatening CRBSI is a major complication of HPN; strict adherence to care protocols reduces risk. Carers may appear technically competent when formally assessed, but the burden of responsibility compounded by other family difficulties may result in adverse outcomes. Comprehensive assessment and social work support should be integral to an HPN service. Change of carer may be more appropriate than ITx. Disclosure of Interest: None declared.
P281 TASTE ACUITY FOR SALT AND ACHIEVEMENT OF SALT RESTRICTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE Y. Kanazawa1 , T. Nakao2 , H. Matsumoto2 , T. Okada2 , Y. Nagaoka2 . 1 Department of Life Science, Tokyo Kasei Gakuin Junior College, 2 Department of Nephrology, Tokyo Medical University, Tokyo, Japan Rationale: Salt restriction is a fundamental issue in the management of chronic kidney disease (CKD). There are few data on taste acuity for salt (TAS) and its association with compliance of dietary salt restriction in CKD patients. Methods: In this study, 248 CKD patients (165 men and 83 women) who were instructed to restrict salt intake were recruited. TAS was quantified by determining the threshold of response to a set of test papers with various concentrations of salt crystals (Salsave, Toyo Roshi Kaisha). Salt intake was estimated by measuring sodium excretion in 24-hour urine collection. Results: The studied CKD patients were classified in 42 of stage 1 (S1), 32 of stage 2 (S2), 74 of stage 3 (S3), 56 of stage 4 (S4) and 44 of stage 5 (S5). The thresholds of response to salt concentration (%) were 0.91±0.36 in S1, 0.87±0.35 in S2, 0.97±0.37 in S3, 1.02±0.34 in S4 and 1.12±0.43 in S5 patients, and TAS was significantly more impaired in S5 than in both S1 and S2 (p < 0.05). Estimated salt intakes (g/day) were 10.5±4.1 in S1, 8.5±3.7 in S2, 8.1±3.0 in S3, 8.0±2.7 in S4 and 6.7±2.5 in S5 patients, being significantly lower in S5 than others (p < 0.05) and significantly lower in S4 than S1 patients (p < 0.05). Compliance with salt restriction was best in S5 patients, though TAS was significantly impaired. Furthermore, among S5 patients, actual daily salt intake was 6.2±0.5 g in those who judged their own salt intake as excessive, 8.3±2.6 g in those considering it
143
aiming to evaluate clinical practices in dialysis. Data from more than 9,000 maintenance hemodialysis patients were collected in June 2008 in a cross-sectional manner. Results: Protein intake, derived from protein nitrogen appearance, was satisfactory according to the latest recommendations (nPNA 1.0 g protein/kg/d). However, 58.7% of patients had serum albumin lower than 38 g/l, potentially explained by a chronic inflammation. Indeed, 58.5% of patients had a C-Protein Reactive above 5 mg/l. More than half of the patients had serum phosphate level within the current phosphocalcic target. The use of native vitamin D only reached 30% of patients; the mean 25(OH) serum level was 21.6±20.0 mg/l, corresponding to a deficient state. Table: Patients Age (years), Mean±SD Body Mass Index (kg/m2 ), Mean±SD Protein intake (g/kg/d), Mean±SD S Albumin (g/l), Mean±SD C-reactive protein (mg/l), Mean±SD/Median S phosphorus (mmol/l), Mean±SD
n = 125 67.9±14.6 24.9±5.2 1.13±0.40 36.4±5.1 13.6±26.3/5.9 1.5±0.5
Conclusion: This up-to-date analysis shows that despite adequate protein intake, maintenance hemodialysis patients have a very low serum albumin level, potentially explained by a chronic inflammation. Both factors are strongly linked to mortality. Prospective follow-up of the Photo-Graph cohort will allow to determine whether different treatments affect clinical outcome in dialysis patients. Disclosure of Interest: D. Fouque, Genzyme, Grant Research Support
P280 LIFE THREATENING SEPSIS DURING HOME PARENTERAL NUTRITION MAY BE AN INDICATION FOR FOSTER CARE V. Zamvar1 , G. Lazonby2 , J.W. Puntis1 . 1 Paediatric Gastroenterology, 2 Paediatric Gastroenterology and Nutrition, The General Infirmary at Leeds, Leeds, United Kingdom Rationale: While offering an improved quality of life, home parenteral nutrition (HPN) burdens parents with major responsibilities. Although recurrent life threatening catheter related blood stream infection (CRBSI) is an indication for intestinal transplantation (ITx), it may also reflect unrecognised parental difficulty with management compliance. Aims: to review HPN patients with life threatening CRBSI and assess the impact of change of carers on clinical progress. Methods: Case notes review. Results: Out of 37 children enrolled into an HPN programme, 2 had frequent CRBSI requiring repeated admission to paediatric intensive care (PICU). After assessment, both were recommended for ITx. An 8 m old girl with SBS-complicated gastroschisis was discharged home on PN. Both parents were willing and judged competent to undertake home care. There were complex social issues in the family but there was little input from social services. Over the next 3 years she had 32
episodes of CRBSI with 3 admissions to PICU for cardiorespiratory support. Parents appeared slow at recognising signs of sepsis, did not visit during hospital admissions, and eventually admitted to not being able to cope. Subsequently discharged into foster care, there has been only one episode of CRBSI in 3 years, managed simply with antibiotics. A 3 m old girl with SBS secondary to neonatal volvulus was discharged on HPN. Her single mother was willing and competent to take on this responsibility, and over the first 15 months there were 5 episodes of CRBSI. During the next 15 mo she had 16 episodes of CRBSI with four admissions to PICU. Following discussions with the family and social services, the child went into voluntary foster care with grandparents. Six months later, there have been no further episodes of CRBSI. Conclusion: Life threatening CRBSI is a major complication of HPN; strict adherence to care protocols reduces risk. Carers may appear technically competent when formally assessed, but the burden of responsibility compounded by other family difficulties may result in adverse outcomes. Comprehensive assessment and social work support should be integral to an HPN service. Change of carer may be more appropriate than ITx. Disclosure of Interest: None declared.
P281 TASTE ACUITY FOR SALT AND ACHIEVEMENT OF SALT RESTRICTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE Y. Kanazawa1 , T. Nakao2 , H. Matsumoto2 , T. Okada2 , Y. Nagaoka2 . 1 Department of Life Science, Tokyo Kasei Gakuin Junior College, 2 Department of Nephrology, Tokyo Medical University, Tokyo, Japan Rationale: Salt restriction is a fundamental issue in the management of chronic kidney disease (CKD). There are few data on taste acuity for salt (TAS) and its association with compliance of dietary salt restriction in CKD patients. Methods: In this study, 248 CKD patients (165 men and 83 women) who were instructed to restrict salt intake were recruited. TAS was quantified by determining the threshold of response to a set of test papers with various concentrations of salt crystals (Salsave, Toyo Roshi Kaisha). Salt intake was estimated by measuring sodium excretion in 24-hour urine collection. Results: The studied CKD patients were classified in 42 of stage 1 (S1), 32 of stage 2 (S2), 74 of stage 3 (S3), 56 of stage 4 (S4) and 44 of stage 5 (S5). The thresholds of response to salt concentration (%) were 0.91±0.36 in S1, 0.87±0.35 in S2, 0.97±0.37 in S3, 1.02±0.34 in S4 and 1.12±0.43 in S5 patients, and TAS was significantly more impaired in S5 than in both S1 and S2 (p < 0.05). Estimated salt intakes (g/day) were 10.5±4.1 in S1, 8.5±3.7 in S2, 8.1±3.0 in S3, 8.0±2.7 in S4 and 6.7±2.5 in S5 patients, being significantly lower in S5 than others (p < 0.05) and significantly lower in S4 than S1 patients (p < 0.05). Compliance with salt restriction was best in S5 patients, though TAS was significantly impaired. Furthermore, among S5 patients, actual daily salt intake was 6.2±0.5 g in those who judged their own salt intake as excessive, 8.3±2.6 g in those considering it