KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update

Abstract

Pages S1-S124 Saunders an Imprint of Elsevier Supplement to K KD DO OQ QI I C Cl li in ni ic ca al l P Pr ra ac ct ti ic ce e G Gu ui id de el li in ne e f fo or r N Nu ut tr ri it ti io on n i in n C Ch hi il ld dr re en n w wi it th h C Abstract T he 2008 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) pediatric nutrition clinical practice guideline is intended to assist the practitioner caring for infants, children, and adolescents with chronic kidney disease (CKD) stages 2 to 5, on long-term dialysis therapy, or with a kidney transplant. The guideline contains recommendations for evaluation of nutritional status and growth and for counseling and selecting nutrition therapies that are appropriate to age and CKD stage. Therapeutic interventions considered include enteral feeding, intradialytic parenteral nutrition, growth hormone therapy, and restriction or supplementation of various macro-and micronutrients. The Work Group drafted narrative reviews based on its expertise and knowledge of the literature in the field and used references to support its write-up. Given the heterogeneity and often unique circumstances of the disease conditions in children with CKD, the Work Group adopted a perspective of issuing recommendations of potential use for improving patient survival, health, and quality of life. The recommendations also underwent both internal and external review. Tables of food and formula nutrient content, procedures for anthropometric measurements, copies of growth charts, and a list of resources for calculating energy requirements and anthropometric z scores are provided to assist with implementation. Furthermore, limitations to the recommendations are discussed; comparisons to other guidelines are made; and recommendations are provided for future research. Executive Summary S13 ance for dialytic protein and amino acid losses. (C) 5.3 The use of protein supplements to augment inadequate oral and/or enteral protein intake should be considered when children with CKD stages 2 to 5 and 5D are unable to meet their protein requirements through food and fluids alone. (B) Recommendation 6: Vitamin and Trace Element Requirements and Therapy 6.1 The provision of dietary intake consisting of at least 100% of the DRI for thiamin (B 1 ), riboflavin (B 2 ), niacin (B 3 ), pantothenic acid (B 5 ), pyridoxine (B 6 ), biotin (B 8 ), cobalamin (B 12 ), ascorbic acid (C), retinol (A), ␣-tocopherol (E), vitamin K, folic acid, copper, and zinc should be considered for children with CKD stages 2 to 5 and 5D. (B) 6.2 It is suggested that supplementation of vitamins and trace elements be provided to children with CKD stages 2 to 5 if dietary intake alone does not meet 100% of the DRI or if clinical evidence of a deficiency, possibly confirmed by low blood levels of the vitamin or trace element, is present. (C) 6.3 It is suggested that children with CKD stage 5D receive a water-soluble vitamin supplement. (C) Recommendation 7: Bone Mineral and Vitamin D Requirements and Therapy 7.1: Calcium 7.1.1 In children w...

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

“…Six CKD 5D children aged between 11 mo and 14 years who had uncontrolled SHPT and treated with cinacalcet (doses: 0.4-1.4 mg/kg) showed satisfactory and sustained correction of the hyperparathyroidism [112] . Whatever medication that is chosen for the hyperparathyroidism, it is suggested that the target serum PTH in CKD 3, CKD 4, and CKD 5/5D should, respectively be in the 35-70, 70-110, and 200-300 pg/mL range to avoid adynamic bone disease from too low serum PTH [113] . In CKD, the serum PTH should be maintained within 2-9 times the upper limits of the normal laboratory range [76] .…”

Proflie of Human β-Defensins 1,2 and Proinflammatory Cytokines (TNF-α, IL-6) in Patients with Chronic Kidney Disease

“…The diagnosis of CKD has been classified into stages based principally upon estimated GFR (eGFR) using the IDMS-traceable modified MDRD (Modification of Diet in Renal Disease) and the assessment of proteinuria. The 5 stage classification of CKD based on eGFR as proposed by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and modified by National Institute for Health and Clinical Excellence (NICE) [12,13]. Each stage group of 1, 2, 3, 4, and 5 comprised normal or increased eGFR (n = 10), eGFR 89-60 ml/min per 1.73 m 2 (n = 39), eGFR 59-30 ml/min per 1.73 m 2 (n = 102), eGFR 29-15 ml/min per 1.73 m 2 (n = 31) and eGFR <15 ml/min per 1.73 m 2 (n = 156) [14].…”

Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD)

“…The Kidney Disease Outcomes Quality Initiatives (KDOQI) pediatric nutrition guideline, considered a foundation for clinical nutrition care and practice for individuals with CKD, highlight several factors influencing the need for nutritional adjustment in children with CKD, including age, developmental stage, treatment or dialysis modality, residual kidney function, comorbidities, prematurity, decreased appetites or energy intake, acidosis, sodium losses, mineral bone disorders, and abnormalities in the growth hormone-insulin like growth factor axis (1, 2, 4). Poor growth has serious consequences, including hospitalization, mortality and poor quality of life (5).…”

“…Growth in chronic kidney disease (CKD) is a multifaceted clinical issue, complicated by physiologic linear height impairment, uremia, and frequently, developmental age lagging behind chronological age (1, 2). A unique aspect impacting growth in CKD is the need to tailor enteral feeding regimens in terms of route, formula type, and modulation of the enteral product to fit individual patient needs.…”

“…A unique aspect impacting growth in CKD is the need to tailor enteral feeding regimens in terms of route, formula type, and modulation of the enteral product to fit individual patient needs. Adjustments include accommodating dialysate volumes, variations based on type of dialysis, electrolyte management, gastrointestinal symptoms and psychosocial challenges common with CKD (1, 3). This review aims to highlight the specific challenges associated with optimizing enteral feeding to promote growth, especially in young children with CKD.…”