Growth and Nutrition in Pediatric Chronic Kidney Disease

Silverstein, Douglas M.

doi:10.3389/fped.2018.00205

Cited by 51 publications

(40 citation statements)

References 127 publications

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“…Nutritional management was based on published guidelines and our pediatric renal nutrition specialist (22, 23). Nutritional aims were to provide 100% of estimated nutrient requirements for energy and supplemental protein as indicated for dialysis losses.…”

Section: Methodsmentioning

confidence: 99%

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

et al. 2019

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Recent advances in the early diagnosis of fetal CAKUT with an increase in fetal surgical interventions have led to a growing number of neonatal survivors born with severe renal dysfunction. This, in turn, has required the development of multi-disciplinary treatment paradigms in the individualized management of these infants with advanced stage kidney disease from birth. Early multi-modal management includes neonatal surgical interventions directed toward establishing adequate urine flow, respiratory support with the assessment of pulmonary hypoplasia, and establishing metabolic control to avoid the need for dialysis intervention. The development of specialized imaging to assess for residual renal mass with non-invasive 3-dimensional techniques are rapidly evolving. The use of non-radioactive imaging offers improved safety and allows for early prognostic-based planning including anticipatory guidance for progression to end stage renal disease (ESRD). The trajectory of kidney function during the neonatal period as determined by peak and nadir serum creatinine (SCr) and cystatin C (CysC) during the first months of life provides a guide toward individualized prospective management. This is a single center experience based on a birth cohort of 42 subjects followed prospectively from birth for an average of 6.1 ± 2.8 years at the University of Miami/Holtz Children's Hospital during the past decade. There was an 8:1 male: female ratio. The birth cohort was divided into 3 subgroups according to CKD Stages at the current age: CKD 1–2 (Group 1) (eGFR ≥ 60 ml/min/1.73 m 2 ) ( N = 15), CKD stage 3–5 (Group 2) (eGFR ≤ 59 ml/min/1.73 m 2 ) ( N = 12), and ESRD—Dialysis and/or Transplantation (Group 3) ( N = 15). A neonatal CysC >3.0 mg/L predicted progression to ESRD while a nadir SCr >0.6 mg/dL predicted progression to CKD 3–5 with the highest specificity and sensitivity by ROC-AUC analysis ( P < 0.0001). Medical management was directed toward nutritional support with novel formula designs, early introduction of growth hormone and strict control of mineral bone disorder. One of the central aspects of the management was to avoid dialysis for as long as feasible with a primary goal toward pre-emptive transplantation.

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Section: Methodsmentioning

confidence: 99%

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

et al. 2019

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“…What is more, nutrition plays a vital role in the development of the brain during the postnatal and preschool periods, as neurons undergo rapid development and synaptic pruning during the first five years of life. Unfortunately, children who suffer from CKD are faced with impaired nutritional status directly resulting in sub-optimal growth [ 72 ]. This may be attributed to growth hormone and insulin-like growth factor I axis dysregulation, metabolic acidosis, anemia, nutritional deficiencies, renal osteodystrophy and inflammation [ 72 ].…”

Section: Nutritional Recommendations For Pediatric Patients Treatementioning

confidence: 99%

“…Unfortunately, children who suffer from CKD are faced with impaired nutritional status directly resulting in sub-optimal growth [ 72 ]. This may be attributed to growth hormone and insulin-like growth factor I axis dysregulation, metabolic acidosis, anemia, nutritional deficiencies, renal osteodystrophy and inflammation [ 72 ]. Fabio et al, suggest that cachexia or protein-calorie malnutrition is a problem that many PD-treated children encounter and contributes to morbidity and mortality [ 73 ].…”

Section: Nutritional Recommendations For Pediatric Patients Treatementioning

confidence: 99%

Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition

et al. 2020

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The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.

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“…A major breakthrough in the management of uremic growth failure is the introduction of recombinant human growth hormone (rhGH), which overcomes CKD-associated GH insensitivity and thereby increases growth outcome in children with CKD (15). A detailed review on growth and nutrition in pediatric CKD was recently published in this journal (16). This article discusses the main measures to optimize growth in children with CKD during the various stages of kidney disease, i.e., prior to dialysis, on dialysis, and after kidney transplantation, based on published guidelines.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

Haffner

2020

Front. Pediatr.

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Growth failure is a hallmark in children with chronic kidney disease (CKD). Therefore, early diagnosis and adequate management of growth failure is of utmost importance in these patients. The risk of severe growth retardation is the higher the younger the child is, which places an additional burden on patients and their families and hampers the psychosocial integration of these children. Careful monitoring of growth, and effective interventions are mandatory to prevent and treat growth failure in children with CKD at all ages and all stages of kidney failure. Early intervention is critical, as all therapeutic interventions are much more effective if they are started prior to the initiation of dialysis. Prevention and treatment of growth failure focuses on: (i) preservation of renal function, e.g., normalization of blood pressure and proteinuria by use of inhibitors of the renin-angiotensin aldosterone system, (ii) adequate energy intake, including tube feeding or gastrostomy in case of persisting malnutrition, (iii) substitution of water and electrolytes, especially in children with renal malformation, (iv) correction of metabolic acidosis, (v) control of parathyroid hormone levels within the CKD-dependent target range, (vi) use of recombinant human growth hormone in cases of persistent growth failure, and, (vii) early/preemptive kidney transplantation using steroid-minimizing immunosuppressive protocols in children with end-stage CKD. This review discusses these measures based on recent guidelines.

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Growth and Nutrition in Pediatric Chronic Kidney Disease

Cited by 51 publications

References 127 publications

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

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