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Pediatric Nephrology
Published in: Pediatric Nephrology 9/2012

01-09-2012 | Review

Nutrition in infants and very young children with chronic kidney disease

Authors: Bethany J. Foster, Lynn McCauley, Robert H. Mak

Published in: Pediatric Nephrology | Issue 9/2012

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Abstract

Provision of adequate nutrition is a cornerstone of the management of infants and very young children with chronic kidney disease (CKD). Very young children with CKD frequently have poor spontaneous nutritional intake. Because growth depends strongly on nutrition during early childhood, growth in very young children with CKD is often suboptimal. In this review we will consider the mechanisms and manifestations of inadequate nutritional status in very young children with CKD, mechanisms mediating inadequate nutritional intake, and the optimal nutritional management of this special population. In addition, we suggest an approach to the assessment of nutritional status, including the use of body mass index in infants. Five major nutritional components are considered: energy, macronutrients, fluids and electrolytes, micronutrients, and calcium/phosphorus/vitamin D. The use of adjunctive therapies, including appetite stimulants, treatment of gastroesophageal reflux and gastric dysmotility, enhanced dialytic clearance, and growth hormone, is also briefly discussed.
Literature
1.
Wong CS, Gipson DS, Gillen DL, Emerson S, Koepsell T, Sherrard DJ, Watkins SL, Stehman-Breen C (2000) Anthropometric measures and risk of death in children with end-stage renal disease. Am J Kidney Dis 36:811–819PubMedCrossRef
2.
Karlberg J, Engstrom I, Karlberg P, Fryer JG (1987) Analysis of linear growth using a mathematical model. I. From birth to three years. Acta Paediatr Scand 76:478–488PubMedCrossRef
3.
Karlberg J, Fryer JG, Engstrom I, Karlberg P (1987) Analysis of linear growth using a mathematical model. II. From 3 to 21 years of age. Acta Paediatr Scand Suppl 337:12–29PubMedCrossRef
4.
Karlberg J, Schaefer F, Hennicke M, Wingen AM, Rigden S, Mehls O (1996) Early age-dependent growth impairment in chronic renal failure. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Pediatr Nephrol 10:283–287PubMed
5.
Evans D, Hansen JD, Moodie AD, van der Spuy HI (1980) Intellectual development and nutrition. J Pediatr 97:358–363PubMedCrossRef
6.
7.
Foster BJ, Leonard MB (2004) Measuring nutritional status in children with chronic kidney disease. Am J Clin Nutr 80:801–814PubMed
8.
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevinho-Becerra A, Wanner C (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73:391–398PubMedCrossRef
9.
10.
Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD (2008) Cachexia: a new definition. Clin Nutr 27:793–799PubMedCrossRef
11.
Foster BJ, Kalkwarf HJ, Shults J, Zemel BS, Wetzsteon RJ, Thayu M, Foerster DL, Leonard MB (2010) Association of chronic kidney disease with muscle deficits in children. J Am Soc Nephrol. doi:10.​1681/​ASN.​2010060603
12.
Abitbol CL, Zilleruelo G, Montane B, Strauss J (1993) Growth of uremic infants on forced feeding regimens. Pediatr Nephrol 7:173–177PubMedCrossRef
13.
Claris-Appiani A, Ardissino GL, Dacco V, Funari C, Terzi F (1995) Catch-up growth in children with chronic renal failure treated with long-term enteral nutrition. JPEN J Parenter Enteral Nutr 19:175–178PubMedCrossRef
14.
Ledermann SE, Shaw V, Trompeter RS (1999) Long-term enteral nutrition in infants and young children with chronic renal failure. Pediatr Nephrol 13:870–875PubMedCrossRef
15.
Jones RW, Rigden SP, Barratt TM, Chantler C (1982) The effects of chronic renal failure in infancy on growth, nutritional status and body composition. Pediatr Res 16:784–791PubMedCrossRef
16.
KDOQI (2009) KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53:S11–S104
17.
18.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL (2000) CDC growth charts: United States. Adv Data 314:1–17PubMed
19.
20.
Dieticians of Canada CPS, College of Family Physicians of Canada, Community Health Nurses Association of Canada Nutrition Committee, Canadian Pediatric Society (2004) The use of growth charts for assessing and monitoring growth in Canadian infants and children. Paediatr Child Health 9:171–180
21.
American Academy of Pediatrics Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee (2007) Recommendations for preventive pediatric health care. Pediatrics 120:1376CrossRef
22.
Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L (2000) Outcome and growth of infants with severe chronic renal failure. Kidney Int 57:1681–1687PubMedCrossRef
23.
Parekh RS, Flynn JT, Smoyer WE, Milne JL, Kershaw DB, Bunchman TE, Sedman AB (2001) Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol 12:2418–2426PubMed
24.
Charra B, Calemard E, Cuche M, Laurent G (1983) Control of hypertension and prolonged survival on maintenance hemodialysis. Nephron 33:96–99PubMedCrossRef
25.
Lucke T, Franke D, Clewing JM, Boerkoel CF, Ehrich JH, Das AM, Zivicnjak M (2006) Schimke versus non-Schimke chronic kidney disease: an anthropometric approach. Pediatrics 118:e400–e407PubMedCrossRef
26.
Zivicnjak M, Franke D, Filler G, Haffner D, Froede K, Nissel R, Haase S, Offner G, Ehrich JH, Querfeld U (2007) Growth impairment shows an age-dependent pattern in boys with chronic kidney disease. Pediatr Nephrol 22:420–429PubMedCrossRef
27.
Schaefer F, Wuhl E, Feneberg R, Mehls O, Scharer K (2000) Assessment of body composition in children with chronic renal failure. Pediatr Nephrol 14:673–678PubMedCrossRef
28.
Warady BA, Belden B, Kohaut E (1999) Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy. Pediatr Nephrol 13:759–765PubMedCrossRef
29.
30.
Champagne CM, Baker NB, DeLany JP, Harsha DW, Bray GA (1998) Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children. J Am Diet Assoc 98:426–433PubMedCrossRef
31.
Livingstone MB, Robson PJ (2000) Measurement of dietary intake in children. Proc Nutr Soc 59:279–293PubMedCrossRef
32.
Donckerwolcke R, Yang WN, Chan JC (1989) Growth failure in children with renal tubular acidosis. Semin Nephrol 9:72–74PubMed
33.
Mitch WE, Goldberg AL (1996) Mechanisms of muscle wasting. The role of the ubiquitin-proteasome pathway. N Engl J Med 335:1897–1905PubMedCrossRef
34.
Rajan VR, Mitch WE (2008) Muscle wasting in chronic kidney disease: the role of the ubiquitin proteasome system and its clinical impact. Pediatr Nephrol 23:527–535PubMedCrossRef
35.
Rodriguez-Soriano J, Arant BS, Brodehl J, Norman ME (1986) Fluid and electrolyte imbalances in children with chronic renal failure. Am J Kidney Dis 7:268–274PubMed
36.
Wassner SJ, Kulin HE (1990) Diminished linear growth associated with chronic salt depletion. Clin Pediatr (Phila) 29:719–721CrossRef
37.
Jones CH, Wells L, Stoves J, Farquhar F, Woodrow G (2002) Can a reduction in extracellular fluid volume result in increased serum albumin in peritoneal dialysis patients? Am J Kidney Dis 39:872–875PubMedCrossRef
38.
Kalantar-Zadeh K, Kopple JD (2001) Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis 38:1343–1350PubMedCrossRef
39.
Yeun JY, Levine RA, Mantadilok V, Kaysen GA (2000) C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 35:469–476PubMedCrossRef
40.
Sharma A (2001) Reassessing hemodialysis adequacy in children: the case for more. Pediatr Nephrol 16:383–390PubMedCrossRef
41.
Silverstein DM, Sgambat K, Fragale M, Moylan K, McCarter RJ, Kher KK (2009) Assessment of relationship between nutrition and growth in pediatric hemodialysis patients. J Ren Nutr 19:422–431PubMedCrossRef
42.
Juarez-Congelosi M, Orellana P, Goldstein SL (2007) Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J Ren Nutr 17:269–274PubMedCrossRef
43.
Bellisle F, Dartois AM, Kleinknecht C, Broyer M (1995) Alteration of the taste for sugar in renal insufficiency: study in the child. Nephrologie 16:203–208PubMed
44.
Cheung WW, Paik KH, Mak RH (2010) Inflammation and cachexia in chronic kidney disease. Pediatr Nephrol 25:711–724PubMedCrossRef
45.
Mak RH, Cheung W, Cone RD, Marks DL (2006) Leptin and inflammation-associated cachexia in chronic kidney disease. Kidney Int 69:794–797PubMedCrossRef
46.
Mak RH, Cheung W, Purnell J (2007) Ghrelin in chronic kidney disease: too much or too little? Perit Dial Int 27:51–55PubMed
47.
Coleman JE, Warady BA (2004) Supplemental tube feeding. In: Warady BA, Schaefer F, Fine RN, Alexander SR (eds) Pediatric dialysis. Kluwer Academic Publisher, pp 243–257CrossRef
48.
Dello Strologo L, Principato F, Sinibaldi D, Appiani AC, Terzi F, Dartois AM, Rizzoni G (1997) Feeding dysfunction in infants with severe chronic renal failure after long-term nasogastric tube feeding. Pediatr Nephrol 11:84–86PubMedCrossRef
49.
Rees L (2002) Management of the infant with end-stage renal failure. Nephrol Dial Transplant 17:1564–1567PubMedCrossRef
50.
Rees L, Brandt ML (2010) Tube feeding in children with chronic kidney disease: technical and practical issues. Pediatr Nephrol 25:699–704PubMedCrossRef
51.
Mekahli D, Shaw V, Ledermann SE, Rees L (2010) Long-term outcome of infants with severe chronic kidney disease. Clin J Am Soc Nephrol 5:10–17PubMedCrossRef
52.
Hobbs DJ, Gast TR, Ferguson KB, Bunchman TE, Barletta GM (2010) Nutritional management of hyperkalemic infants with chronic kidney disease, using adult renal formulas. J Ren Nutr 20:121–126PubMedCrossRef
53.
54.
Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM, Pencharz PB (1992) Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 120:569–572PubMedCrossRef
55.
Billeaud C, Guillet J, Sandler B (1990) Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr 44:577–583PubMed
56.
Tolia V, Lin CH, Kuhns LR (1992) Gastric emptying using three different formulas in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 15:297–301PubMedCrossRef
57.
Woodley FW, Mousa H (2008) Revisiting the effect of casein and whey on gastric emptying: do differences in protein source really matter? J Neonatal-Perinatal Med 1:111–117
58.
Raiha NC (1985) Protein quality in feeding the normal infant: do whey-predominant formulas offer nutritional advantages? Pediatrics 76:329PubMed
59.
Nelms CL, Juarez M, Warady BA (2010) Renal disease. In: Corkins MR (ed) The American Society for Parenteral and Enteral Nutrition Pediatric Nutrition Support Core Curriculum. The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, pp 256–282
60.
Lien EL (2003) Infant formulas with increased concentrations of alpha-lactalbumin. Am J Clin Nutr 77:1555S–1558SPubMed
61.
Rees L, Shaw V (2007) Nutrition in children with CRF and on dialysis. Pediatr Nephrol 22:1689–1702PubMedCrossRef
62.
Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE (1991) Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatr Nephrol 5:29–32PubMedCrossRef
63.
National Kidney Foundation (2005) K/DOQI Clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 46:S1–S122
64.
Secker D, Mak RH (2008) Nutritional challenges in pediatric chronic kidney disease. In: Geary D, Schaefer F (eds) Comprehensive Pediatric Nephrology, pp 743–760
65.
Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS (2000) Long-term outcome of peritoneal dialysis in infants. J Pediatr 136:24–29PubMedCrossRef
66.
Sienna JL, Saqan R, The JC, Frieling ML, Secker D, Cornelius V, Geary DF (2010) Body size in children with chronic kidney disease after gastrostomy tube feeding. Pediatr Nephrol 25:2115–2121PubMedCrossRef
67.
Kamen RS (1990) Impaired development of oral-motor functions required for normal oral feeding as a consequence of tube feeding during infancy. Adv Perit Dial 6:276–278PubMed
68.
Calka O, Metin A, Dulger H, Erkoc R (2005) Effect of cyproheptadine on serum leptin levels. Adv Ther 22:424–428PubMedCrossRef
69.
Mahachoklertwattana P, Wanasuwankul S, Poomthavorn P, Choubtum L, Sriphrapradang A (2009) Short-term cyproheptadine therapy in underweight children: effects on growth and serum insulin-like growth factor-I. J Pediatr Endocrinol Metab 22:425–432PubMedCrossRef
70.
Homnick DN, Homnick BD, Reeves AJ, Marks JH, Pimentel RS, Bonnema SK (2004) Cyproheptadine is an effective appetite stimulant in cystic fibrosis. Pediatr Pulmonol 38:129–134PubMedCrossRef
71.
Couluris M, Mayer JL, Freyer DR, Sandler E, Xu P, Krischer JP (2008) The effect of cyproheptadine hydrochloride (periactin) and megestrol acetate (megace) on weight in children with cancer/treatment-related cachexia. J Pediatr Hematol Oncol 30:791–797PubMedCrossRef
72.
Hobbs DJ, Bunchman TE, Weismantel DP, Cole MR, Ferguson KB, Gast TR, Barletta GM (2010) Megestrol acetate improves weight gain in pediatric patients with chronic kidney disease. J Ren Nutr 20:408–413PubMedCrossRef
73.
Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, Luciani G (2005) Malnutrition in hemodialysis patients: what therapy? Am J Kidney Dis 46:371–386PubMedCrossRef
74.
Loprinzi CL, Jensen MD, Jiang NS, Schaid DJ (1992) Effect of megestrol acetate on the human pituitary-adrenal axis. Mayo Clin Proc 67:1160–1162PubMed
75.
Mann M, Koller E, Murgo A, Malozowski S, Bacsanyi J, Leinung M (1997) Glucocorticoidlike activity of megestrol. A summary of Food and Drug Administration experience and a review of the literature. Arch Intern Med 157:1651–1656PubMedCrossRef
76.
Ruley EJ, Bock GH, Kerzner B, Abbott AW, Majd M, Chatoor I (1989) Feeding disorders and gastroesophageal reflux in infants with chronic renal failure. Pediatr Nephrol 3:424–429PubMedCrossRef
77.
De S, Taylor CM (2007) Domperidone toxicity in an infant on maintenance haemodialysis. Pediatr Nephrol 22:161–162PubMedCrossRef
78.
Strid H, Fjell A, Simren M, Bjornsson ES (2009) Impact of dialysis on gastroesophageal reflux, dyspepsia, and proton pump inhibitor treatment in patients with chronic renal failure. Eur J Gastroenterol Hepatol 21:137–142PubMedCrossRef
79.
Stompor T, Hubalewska-Hola A, Staszczak A, Sulowicz W, Huszno B, Szybinski Z (2002) Association between gastric emptying rate and nutritional status in patients treated with continuous ambulatory peritoneal dialysis. Perit Dial Int 22:500–505PubMed
80.
De Loore I, Van Ravensteyn H, Ameryckx L (1979) Domperidone drops in the symptomatic treatment of chronic paediatric vomiting and regurgitation. A comparison with metoclopramide. Postgrad Med J 55 [Suppl 1]:40–42PubMed
81.
Van Eygen M, Dhondt F, Heck E, Ameryckx L, Van Ravensteyn H (1979) A double-blind comparison of domperidone and metoclopramide suppositories in the treatment of nausea and vomiting in children. Postgrad Med J 55 [Suppl 1]:36–39PubMed
82.
Pritchard DS, Baber N, Stephenson T (2005) Should domperidone be used for the treatment of gastro-oesophageal reflux in children? Systematic review of randomized controlled trials in children aged 1 month to 11 years old. Br J Clin Pharmacol 59:725–729PubMedCrossRef
83.
84.
Tom A, McCauley L, Bell L, Rodd C, Espinosa P, Yu G, Yu J, Girardin C, Sharma A (1999) Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance. J Pediatr 134:464–471PubMedCrossRef
85.
Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A, Burger MC (2006) Intensified and daily hemodialysis in children might improve statural growth. Pediatr Nephrol 21:1746–1752PubMedCrossRef
86.
Holtta T, Ronnholm K, Jalanko H, Holmberg C (2000) Clinical outcome of pediatric patients on peritoneal dialysis under adequacy control. Pediatr Nephrol 14:889–897PubMedCrossRef
87.
Laakkonen H, Happonen JM, Marttinen E, Paganus A, Holtta T, Holmberg C, Ronnholm K (2010) Normal growth and intravascular volume status with good metabolic control during peritoneal dialysis in infancy. Pediatr Nephrol 25:1529–1538PubMedCrossRef
88.
Fine RN, Attie KM, Kuntze J, Brown DF, Kohaut EC (1995) Recombinant human growth hormone in infants and young children with chronic renal insufficiency. Genentech Collaborative Study Group. Pediatr Nephrol 9:451–457PubMedCrossRef
89.
Franke D, Zivicnjak M, Ehrich JH (2009) Growth hormone treatment of renal growth failure during infancy and early childhood. Pediatr Nephrol 24:1093–1096PubMedCrossRef
90.
Mencarelli F, Kiepe D, Leozappa G, Stringini G, Cappa M, Emma F (2009) Growth hormone treatment started in the first year of life in infants with chronic renal failure. Pediatr Nephrol 24:1039–1046PubMedCrossRef
91.
Santos F, Moreno ML, Neto A, Ariceta G, Vara J, Alonso A, Bueno A, Afonso AC, Correia AJ, Muley R, Barrios V, Gomez C, Argente J (2010) Improvement in growth after 1 year of growth hormone therapy in well-nourished infants with growth retardation secondary to chronic renal failure: results of a multicenter, controlled, randomized, open clinical trial. Clin J Am Soc Nephrol 5:1190–1197PubMedCrossRef
Metadata
Title
Nutrition in infants and very young children with chronic kidney disease
Authors
Bethany J. Foster
Lynn McCauley
Robert H. Mak
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 9/2012
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-011-1983-x

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