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Nutritional management of the child with chronic kidney disease and on dialysis
Vanessa Shaw1, Caroline Anderson2,3, An Desloovere4
1University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
Insights
Optimizing nutrition for children with chronic kidney disease (CKD) is crucial for growth and development. This review integrates guidelines for managing nutritional needs in children aged 1-18 with CKD stages 2-5, including those on dialysis.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Growth and Development
Background:
- Nutritional management is critical for infants with chronic kidney disease (CKD) to ensure normal growth.
- Nutritional needs remain vital beyond infancy, especially in toddlers (2-3 years) and during puberty, to support growth spurts.
- Inadequate intake can lead to stunted adult height and neurodevelopmental issues, while overweight/obesity risk necessitates effective strategies.
Purpose of the Study:
- To integrate the Pediatric Renal Nutrition Taskforce (PRNT) clinical practice recommendations (CPRs).
- To provide a holistic approach to nutritional management for children (1-18 years) with CKD stages 2-5 and on dialysis (CKD2-5D).
- To optimize growth and development in pediatric CKD patients through tailored nutritional care.
Main Methods:
- Review and integration of existing clinical practice recommendations (CPRs) from the Pediatric Renal Nutrition Taskforce (PRNT).
- Focus on children aged 1-18 years with CKD stages 2-5 and those on dialysis (CKD2-5D).
- Holistic approach encompassing toddlers, children, and young persons with CKD.
Main Results:
- Established guidelines for nutritional management across different pediatric age groups with CKD.
- Highlighted the importance of addressing both undernutrition and overweight/obesity in pediatric CKD.
- Emphasized the need for tailored nutritional strategies considering disease progression and dietary changes.
Conclusions:
- Collaboration between physicians and pediatric kidney dietitians is essential for comprehensive care.
- Tailored nutritional interventions are key to optimizing growth, development, and metabolic equilibrium in children with CKD.
- Adherence to integrated CPRs can improve outcomes for pediatric patients with CKD.
Abstract:
While it is widely accepted that the nutritional management of the infant with chronic kidney disease (CKD) is paramount to achieve normal growth and development, nutritional management is also of importance beyond 1 year of age, particularly in toddlers, to support the delayed infantile stage of growth that may extend to 2-3 years of age. Puberty is also a vulnerable period when nutritional needs are higher to support the expected growth spurt. Inadequate nutritional intake throughout childhood can result in failure to achieve full adult height potential, and there is an increased risk for abnormal neurodevelopment. Conversely, the rising prevalence of overweight and obesity among children with CKD underscores the necessity for effective nutritional strategies to mitigate the risk of metabolic syndrome that is not confined to the post-transplant population. Nutritional management is of primary importance in improving metabolic equilibrium and reducing CKD-related imbalances, particularly as the range of foods eaten by the child widens as they get older (including increased consumption of processed foods), and as CKD progresses. The aim of this review is to integrate the Pediatric Renal Nutrition Taskforce (PRNT) clinical practice recommendations (CPRs) for children (1-18 years) with CKD stages 2-5 and on dialysis (CKD2-5D). We provide a holistic approach to the overall nutritional management of the toddler, child, and young person. Collaboration between physicians and pediatric kidney dietitians is strongly advised to ensure comprehensive and tailored nutritional care for children with CKD, ultimately optimizing their growth and development.
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