Optimising nutrition in chronic renal insufficiency--growth

Area of Science:

• Pediatric Nephrology
• Nutritional Science
• Growth Monitoring

Background:

• Optimizing nutrition is crucial for growth in infants with chronic renal insufficiency (CRI).
• Less emphasis is placed on nutritional interventions for older children or those with milder CRI.
• Growth outcomes and energy intake in pediatric CRI require further investigation.

Purpose of the Study:

• To prospectively monitor energy intake and growth in children aged 2-16 years with varying degrees of CRI over two years.
• To assess the impact of medical and dietetic care on growth parameters in pediatric patients with CRI.
• To evaluate the correlation between energy intake, supplement adherence, and growth outcomes in children with CRI.

Main Methods:

• Prospective monitoring of 51 children (aged 2-16) with mild, moderate, and severe CRI over 2 years.
• Group classification based on estimated glomerular filtration rate (GFR) using [(51)Cr]-labelled EDTA.
• Data collection included yearly dietary diaries, anthropometric measurements, and assessment of supplement adherence.

Main Results:

• Mean height standard deviation score (SDS) was maintained in mild/moderate CRI and significantly increased in severe CRI.
• A non-significant reduction in overall energy intake was observed, with poor supplement adherence in severe CRI and under-reporting in mild CRI.
• Improved height or body mass index SDS was noted in children adhering to prescribed supplements, with a correlation between energy intake and height SDS in severe CRI.

Conclusions:

• Regular dietetic advice and optimized energy intake, with attention to supplement adherence, can improve growth in children with CRI, regardless of age or severity.
• Nutritional support should be an integral part of clinical care for pediatric patients with chronic renal insufficiency.
• Early and consistent nutritional interventions are key to optimizing growth outcomes in pediatric kidney disease.