Nutritional therapy in children with chronic renal failure

Children grow most during the first 2 years of life; growth retardation at this time has a major effect on the height of a child. Dietary therapy to maximize growth during the first few years before dialysis and transplantation are generally recommended as important. Energy and protein requirements for children in relation to their body weights are greater than for adults. In addition, the metabolic rate may be increased in uremia. Malnutrition and the metabolic disturbances of uremia appear to be more severe in prepubertal children than in adults and growth in such children is generally poor. This may be related to the lower anabolic drive of the prepuberal child; anabolic steroids may improve growth. Severely limited protein diets are difficult to achieve in children without reducing energy intake. It may be easier to give babies diets high in energy and low in protein with essential amino acid supplements to ensure an adequate essential amino acid intake. Fat intake should be increased to provide sufficient energy without causing hypertriglyceridemia. It is hoped that ketoacids may allow sufficient protein to be consumed as that an adequate energy intake is ensured while reducing nitrogen toxicity.