Nutrition in children with preterminal chronic renal failure. Myth or important therapeutic aid?

Abstract

Nutrition has been believed to be an important therapeutic instrument in children with chronic renal failure (i) for improving growth, and (ii) for slowing down the deterioration of renal function. The therapeutic strategies for both targets may be conflicting, at least in part, since a high calorie intake is needed for optimal growth, whereas a low protein diet, which was believed to protect renal function, places patients at risk of low calorie intake. Dietary manipulations for optimal growth are mainly effective in infants with chronic renal failure. However, growth remains suboptimal even with an energy intake above 80% of RDA. Although a low protein diet is able to slow down the rate of deterioration in renal function in rodent studies, the results of prospective clinical studies were disappointing at least for an observation period up to three years. The conclusions out of meta-analyses of these clinical studies in adults are contradictory. The progression rate was not significantly influenced by protein restriction, whereas renal replacement therapy could be postponed. However, the latter seems to be the effect of weakening uremic symptoms during the phase of end-stage renal failure. According to our present knowledge it is not justified to prescribe special diets to children early in the course of chronic renal failure, but the composition of their nutrition should follow the general concept of an optimal mixed diet.

Optimising nutrition in chronic renal insufficiency?progression of disease

“…Increasing emphasis is being placed on the importance of early intervention in the course of chronic renal insufficiency (CRI) in adults, due to renal failure not only being a clinical concern, but also a growing economical and organisational problem associated with provision of renal replacement therapy [2]. While it is acknowledged that dietary manipulations for optimal growth are effective in infants with CRI, there is more scepticism in striving for optimal nutrition in the older child with CRI [3]. This is related, in part, to the minimal reduction in progression of CRI observed following reduced protein intakes [4].…”

Two different therapeutic regimes in patients with sequelae of hemolytic-uremic syndrome

“…Klahr [35] showed that the effect of retarding the decay in the GFR is stronger when the patients start a low-protein intake early with relatively low levels of plasma creatinine. In children, controlled protein diets have only served to delay the onset of dialysis [36]. Hüseman et al [37] showed that during the 1st year of an acute episode of HUS renal function improved and during the 2nd year effective renal plasma flow stabilized.…”

The Evaluation of Longitudinal Growth in Pediatric Chronic Renal Failure Patients Receiving Conservative Treatment, Continuous Ambulatory Peritoneal Dialysis and Hemodialysis

“…Erken dönemde başlanan, uygun ve yeterli kalori ve besin desteği sağlayan diyet ve tıbbi tedaviyi içine alan konservatif tedavi ve diyaliz tedavisi KBY'li çocuklardaki optimal tedavi yaklaşımlarıdır (12,(16)(17)(18). Ancak çalışmalarda, bu yaklaşımların KBY'nin büyüme üzerine olan tüm negative etkilerini düzeltmeye yeterli olmadığı gösterilmiştir (19,20 (27).…”

“…Özellikle hemodiyaliz hastalarında olmak üzere giderek hasta sayısının azalmış olmasının sonuçları etkilemiş olabileceği düşünülmüştür. Pertea ve ark.nın (17), tarafından yapılan ve 9-17 yaşları arasında kronik diyaliz (SAPD ya da hemodiyaliz) programında olan 16 çocuğun değerlendirildiği çalışmada, 4 yıllık izlem sonunda, tüm hastalarda boy kısalığı olduğu saptanmıştır. Çalışma sonucu olarak geç tanı alma, uzun süreli diyaliz uygulanması (ortalama 39.5 ay) ve gelişen malnütrisyo-nun büyümeyi olumsuz etkileyeceği vurgulanmıştır (3,19 …”