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Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy
Rulan S Parekh1, Joseph T Flynn2, William E Smoyer3
1Departments of Pediatrics and Medicine, Johns Hopkins University, Baltimore, Maryland.
Insights
Nutritional support with sodium and water supplementation improves growth in children with chronic renal insufficiency (CRI). This intervention may delay the need for renal replacement therapy or growth hormone treatment.
Area of Science:
- Pediatric Nephrology
- Pediatric Gastroenterology
- Nutritional Science
Background:
- Children with chronic renal insufficiency (CRI) experiencing polyuric, salt-wasting conditions often face growth impairment due to ongoing fluid and electrolyte losses.
- Failure to correct these losses can significantly hinder a child's growth trajectory.
Purpose of the Study:
- To evaluate the impact of nutritional support, specifically low-caloric-density, high-volume, sodium-supplemented feedings, on the growth of children with polyuric, salt-wasting CRI.
- To compare the growth outcomes of treated children with historic and literature control groups.
Main Methods:
- Twenty-four children with CRI (creatinine clearance <65 ml/min per 1.73 m(2)) received sodium-supplemented feedings.
- Growth was retrospectively analyzed using height standard deviation scores (SDS) and compared to a US Renal Data System population control (n=42) and a literature control (n=12).
- Multivariate analysis controlled for disease severity, renal replacement therapy, primary cause of CRI, and initial height SDS.
Main Results:
- The treatment group showed a significantly greater height standard deviation score (Delta SDS) increase of +1.37 at 1 year compared to the population control (P = 0.017).
- At 2 years, the treatment group exhibited a significantly greater height Delta SDS of +1.83 compared to the literature control (P = 0.003), adjusted for creatinine clearance.
- The primary causes of CRI varied across groups, with obstructive uropathy and dysplasia being most prevalent in the treatment group (92%).
Conclusions:
- Nutritional intervention with sodium and water supplementation effectively maintains or improves growth in children with polyuric, salt-wasting CRI.
- This cost-effective approach may postpone the need for renal replacement therapy and/or growth hormone treatment.
- The intervention is practical for implementation in diverse clinical settings.
Abstract:
Growth in children with chronic renal failure caused by polyuric, salt-wasting diseases may be hampered if ongoing sodium and water losses are not corrected. Twenty-four children were treated with polyuric chronic renal insufficiency (CRI; creatinine clearance <65 ml/min per 1.73 m(2)) with low-caloric-density, high-volume, sodium-supplemented feedings. Subsequent growth was compared with that of children in two control groups: a national historic population control from the US Renal Data System database (n = 42), and a literature control (n = 12). Members of the three groups were 81 to 96% white, and 58 to 70% were boys. Obstructive uropathy and dysplasia were the cause of CRI in 92% of the treatment group, 75% of the literature control group, and 30% of the population control group. Treatment effect was assessed in a multivariate, retrospective analysis of the height standard deviation score (SDS), simultaneously controlling for the severity of disease by renal replacement therapy, primary cause of CRI, and initial height SDS. The change in SDS (Delta SDS) for height by regression analysis at 1 yr was significantly greater by +1.37 in the treatment group versus the population control (P = 0.017). The 2-yr height Delta SDS by regression analysis adjusted for creatinine clearance was significantly greater by +1.83 in the treatment group versus the literature control (P = 0.003). Nutritional support with sodium and water supplementation can maintain or improve the growth of children with polyuric, salt-wasting CRI. This inexpensive intervention may delay the need for renal replacement therapy, growth hormone treatment, or both in many of these children and may be used in any clinical setting.