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Nutritional intervention and growth in children with chronic renal failure
E E Reed1, L P Roy, K J Gaskin
1Department of Nephrology, Royal Alexandra Hospital for Children, Westmead, Australia.
Insights
Tube feeding in children with advanced chronic renal failure did not prevent growth failure or achieve catch-up growth. Nutritional support maintained current growth rates but did not improve them.
Area of Science:
- Pediatric Nephrology
- Nutritional Support
- Growth Monitoring
Background:
- Children with advanced chronic renal disease often experience growth failure.
- Maintaining adequate energy intake is crucial for growth in these patients.
- Congenital renal hypoplasia/dysplasia is a common cause of pediatric renal failure.
Purpose of the Study:
- To evaluate if enhanced energy intake via tube feeding can prevent growth failure in children with congenital renal failure.
- To determine if tube feeding improves growth rates in this pediatric population.
Main Methods:
- A prospective descriptive study was conducted on children with advanced chronic renal disease (GFR < 30 mL/min/1.73 m2).
- Tube feeding was initiated for children with height or weight standard deviation scores (SDS) below -2 or decreasing height SDS.
- Energy requirements were calculated to support catch-up growth, and growth rates were assessed by changes in height and weight SDS.
Main Results:
- Seven infants with congenital renal failure (mean age 0.6 years) were studied.
- All participants received tube feeding for a mean of 18.6 months.
- No significant changes in height SDS (from -0.9 to -1.1) or weight SDS (from -0.4 to -0.2) were observed.
Conclusions:
- Optimizing nutritional intake through tube feeding in young children with advanced chronic renal failure did not lead to a decline in growth rate.
- Despite nutritional intervention, catch-up growth was not achieved in this cohort.
- Early nutritional support is important for maintaining growth trajectory in pediatric renal failure.
Objective:
To assess whether improving energy intake by tube feeding could prevent growth failure and improve growth rates in children with congenital renal failure.
Design:
Prospective descriptive study.
Setting:
Renal Units, Royal Alexandra Hospital for Children, and Westmead Hospitals.
Patients:
All children with advanced chronic renal disease (glomerular filtration rate < 30 mL/min/1.73 m2) between 1992 and 1994.
Intervention:
Tube feeding was commenced if height or weight standard deviation score (SDS) was below the normal range (> -2 SDS) or when height SDS was decreasing and oral intake was not meeting energy requirements. Energy requirements were calculated for median weight for chronological age and sex to provide for catch-up growth.
Main Outcome Measures:
Growth rate was measured by comparing height and weight SDS at the beginning and end of the study period. Normal growth rate is defined as no change in SDS over time, whereas catch-up growth is defined as an increase in SDS over time.
Results:
Seven children, mean age 0.6 +/- 0.7 years, with advanced renal failure (mean glomerular filtration rate = 17 mL/min/1.73 m2) caused by congenital renal hypoplasia/dysplasia were studied. All subjects were eventually tube fed for a mean time of 18. 6 +/- 4.5 months. There was no significant change in height SDS (-0. 9 to -1.1) or weight SDS (-0.4 to -0.2).
Conclusion:
Optimizing nutritional intake by tube feeding children with advanced chronic renal failure from an early age resulted in no decline in growth rate; however, catch-up growth was not achieved.