Related Experiment Videos
Pediatric experience with intradialytic parenteral nutrition and supplemental tube feeding
1Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, USA. ebrewer@bcm.tmc.edu
Insights
Pediatric patients with chronic kidney disease often have poor nutrition, impacting growth and development. Supplemental nutrition, like tube feeding, shows promise, but more research is needed for intradialytic parenteral nutrition (IDPN).
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Growth and Development
Background:
- Optimal nutrition is crucial for pediatric growth and development, yet children with chronic renal failure (CRF) and end-stage renal disease (ESRD) frequently experience anorexia and poor intake.
- Infants and adolescents are particularly vulnerable due to high growth demands, and poor nutrition can negatively impact neurodevelopment, especially in infants.
- Pediatric patients undergoing chronic peritoneal dialysis (PD) face significant protein losses, increasing the risk of protein-calorie malnutrition.
Purpose of the Study:
- To review the nutritional challenges and therapeutic strategies for pediatric patients with chronic kidney disease.
- To assess the current understanding of supplemental nutrition methods, including intradialytic parenteral nutrition (IDPN) and tube feeding, in this population.
- To identify knowledge gaps and areas for future research in optimizing nutritional support for pediatric kidney patients.
Main Methods:
- Literature review focusing on nutritional management in pediatric chronic kidney disease, dialysis, and growth failure.
- Analysis of existing data on the efficacy and safety of various nutritional interventions.
- Discussion of the role of recombinant growth hormone therapy in conjunction with nutritional support.
Main Results:
- Intradialytic parenteral nutrition (IDPN) effectiveness in pediatric patients is not well-established, and further studies are needed, particularly with amino acid-based dialysis fluids for PD.
- Supplemental nasogastric or gastrostomy tube feedings have demonstrated success in improving growth in infants, but data for older children and adolescents is lacking.
- Achieving normal adult height in growth-retarded children with CRF likely requires a multimodal approach including nutrition, recombinant growth hormone, and management of other factors like acidosis and volume depletion.
Conclusions:
- Meeting the nutritional needs of pediatric patients with chronic kidney disease often necessitates supplemental nutrition.
- More research is required to determine the optimal use of IDPN and to evaluate tube feeding efficacy in older pediatric populations.
- A comprehensive management strategy, including nutritional support and potentially growth hormone therapy, is essential for growth-retarded children with CRF.
Abstract:
Good nutrition is necessary to maximize the potential for growth and development in the pediatric age-group, but children, like adults with chronic renal failure and end-stage renal disease, may be anorectic and eat poorly. Infants and adolescents are at special risk because of the intense demands of growth during the first 2 years of life and again during puberty. Neurodevelopment is also adversely affected by poor nutrition, especially in infants. Approximately two-thirds of pediatric dialysis patients are treated with chronic peritoneal dialysis, which results in significant protein losses in the dialysis effluent that can contribute to protein-calorie malnutrition. Meeting the nutritional needs of pediatric patients usually requires supplemental sources, such as intradialytic parenteral nutrition (IDPN) or tube feeding. Little is known about the effectiveness or desirability of IDPN in pediatric patients. More studies, especially of amino acid-based dialysis fluids for chronic peritoneal dialysis, need to be done before making IDPN a standard for pediatrics. Supplemental nasogastric or gastrostomy tube feedings have been very successful in maintaining and improving growth in infants, but no studies are available to evaluate their success in older children and adolescents. Recombinant growth hormone therapy, in addition to good nutrition and control of other growth factors such as acidosis, renal osteodystrophy, and chronic volume depletion, may be necessary for most growth-retarded children with chronic renal failure to achieve normal adult height.