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The nutritional approach for pediatric patients undergoing CAPD/CCPD
1Department of Pediatrics, UCLA School of Medicine.
Insights
Nutritional management for children on continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD) requires tailored caloric, protein, and micronutrient intake based on age and developmental stage. Individualized management of electrolytes and avoidance of aluminum are crucial for optimal outcomes.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Dialysis Therapy
Background:
- Children undergoing peritoneal dialysis (PD) require specific nutritional guidelines.
- Current recommendations for PD patients need review and clarification.
Purpose of the Study:
- To review and outline current nutritional management recommendations for pediatric patients on CAPD/CCPD.
- To provide evidence-based guidance for optimizing nutrition in children undergoing PD.
Main Methods:
- Review of existing literature and established nutritional guidelines.
- Analysis of recommended daily allowances (RDA) for various age groups.
- Examination of specific macronutrient and micronutrient requirements.
Main Results:
- Caloric intake should meet or exceed RDA, with specific targets for pre-pubertal, pubertal, and post-pubertal children.
- Dietary recommendations include 35% complex carbohydrates, 50% fat with a specific polyunsaturated to saturated fatty acid ratio.
- Protein intake varies by age, from 1.5-3.0 gm/kg/day.
- Individualized management of sodium, potassium, and water is necessary.
- Specific vitamin (folic acid, B6, C) and mineral (Vitamin D sterols, calcium carbonate) supplementation is advised.
- Avoidance of aluminum-containing gels is critical to prevent toxicity.
Conclusions:
- Optimizing nutritional intake, including calories, protein, carbohydrates, and fats, is essential for pediatric PD patients.
- Individualized electrolyte and fluid management is key.
- Adequate vitamin and mineral supplementation, alongside phosphate binders, aids in managing complications like renal bone disease.
- Preventing aluminum accumulation is a critical safety consideration.
Abstract:
The current recommendations for the nutritional management of children treated with CAPD/CCPD will be reviewed. The optimal caloric intake for pre-pubertal children undergoing dialysis should at least be determined by the recommended daily allowances (RDA) of the National Academy of Science for healthy children of the same height and age. For pubertal and post-pubertal patients, the prescribed energy intake is similar to the RDA for adolescents, 60 kcal/kg for males, and 48 kcal/kg/day for females. Dietary complex carbohydrates should provide about 35% of dietary energy intake. Dietary fat should provide 50% of the dietary intake, and the PS:S fatty ratio should be about 1.5:1.0. The recommended protein intake for children less than 3 years of age should range between 2.5-3.0 gm/kg/day; for children between 3 years of age and puberty 2.5 gm/kg/day; for pubertal patients 2.0 gm/kg/day, and post-pubertal patients 1.5 gm/kg/day. In general, sodium, potassium and water intake vary markedly among patients and should be managed individually. Vitamins, folic acid 1 mg/day; peridoxine, B6 5-10 mg/day; and ascorbic acid 75-100 mg/day. Vitamin D sterols (i.e., calcitriol) and phosphate binding agents mainly calcium carbonate are needed for the prevention and control of renal bone disease in such patients. Aluminum containing gels should be avoided in order to prevent aluminum accumulation secondary to the ingestion of aluminum containing gels.