Principles of nutrition in chronic kidney disease in children - a review of the clinical trials and recommendations
DOI:
https://doi.org/10.12775/JEHS.2024.72.51249Keywords
chronic kidney disease, chronic diseases, children, macronutrients, micronutrientsAbstract
Introduction: Children with chronic kidney disease (CKD) require a specialized diet to manage their condition and support healthy growth and development. A proper diet for children with CKD aims to control the intake of certain nutrients, such as protein, lipid, calcium, phosphorus, potassium, sodium, and vitamin D, while ensuring they receive adequate nutrition for growth and development.
Aim of the study: This article discusses the epidemiology, causes and pathomechanism of CKD in children. It also presents existing clinical trials and dietary recommendations from societies such as Kidney Disease: Improving Global Outcomes (KDIGO) 2024, Kidney Disease Outcomes Quality Initiative (KDOQI) and Pediatric Renal Nutrition Taskforce (PRNT) and identifies potential sources of selected macronutrients and micronutrients in children's diets.
Materials and methods: Comprehensive literature searches were performed across the main electronic databases of PubMed, Google Scholar, KDIGO2024, KDQQI and PRNT recommendations for studies published in the English language about dietary recommendations for children with CKD.
Results: The approach to nutrition for children with CKD is still evolving, and specific macronutrient and micronutrient ratios should be established based on the clinical condition, the child's age, and body weight. Care should be taken to ensure that the child's diet is varied, and a healthy eating style should be promoted.
References
Amanullah F, Malik AA, Zaidi Z. Chronic kidney disease causes and outcomes in children: Perspective from a LMIC setting. PLoS One. 2022 Jun 8;17(6):e0269632.
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf
Harada R, Hamasaki Y, Okuda Y, Hamada R, Ishikura K. Epidemiology of pediatric chronic kidney disease/kidney failure: learning from registries and cohort studies. Pediatr Nephrol. 2022 Jun;37(6):1215-1229.
VanSickle JS, Warady BA. Chronic Kidney Disease in Children. Pediatr Clin North Am. 2022 Dec;69(6):1239-1254.
Coleman C, Tambay Perez A, Selewski DT, Steflik HJ. Neonatal Acute Kidney Injury. Front Pediatr. 2022 Apr 7;10:842544.
Ameta P, Stoops C, Askenazi DJ. Risk of chronic kidney disease in children who developed acute kidney injury secondary to nephrotoxic medication exposure in infancy. Ren Fail. 2023 Dec;45(1):2218486.
Spoto B, Pisano A, Zoccali C. Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol. 2016 Dec 1;311(6):F1087-F1108.
Strazzella A, Ossoli A, Calabresi L. High-Density Lipoproteins and the Kidney. Cells. 2021 Mar 31;10(4):764.
Kadatane SP, Satariano M, Massey M, Mongan K, Raina R. The Role of Inflammation in CKD. Cells. 2023 Jun 7;12(12):1581.
Hirai T, Yamaga R, Fujita A, Itoh T. Low body mass index is a risk factor for hyperkalaemia associated with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers treatments. J Clin Pharm Ther. 2018 Dec;43(6):829-835.
Sprague SM, Martin KJ, Coyne DW. Phosphate Balance and CKD-Mineral Bone Disease. Kidney Int Rep. 2021 May 17;6(8):2049-2058.
Haffner D, Zivicnjak M. Pubertal development in children with chronic kidney disease. Pediatr Nephrol. 2017 Jun;32(6):949-964.
Kluck R, Müller S, Jagodzinski C, Hohenfellner K, Büscher A, Kemper MJ, Oh J, Billing H, Thumfart J, Weber LT, Acham-Roschitz B, Arbeiter K, Tönshoff B, Hagenberg M, Kanzelmeyer N, Pavičić L, Haffner D, Zivicnjak M. Body growth, upper arm fat area, and clinical parameters in children with nephropathic cystinosis compared with other pediatric chronic kidney disease entities. J Inherit Metab Dis. 2022 Mar;45(2):192-202.
Kilduff S, Hayde N, Viswanathan S, Reidy K, Abramowitz MK. Metabolic acidosis in pediatric kidney transplant recipients. Pediatr Nephrol. 2023 Dec;38(12):4165-4173.
David V, Salusky IB, Malluche H, Nickolas TL. Renal osteodystrophy: something old, something new, something needed. Curr Opin Nephrol Hypertens. 2023 Nov 1;32(6):559-564.
Kouri AM, Rheault MN. Cardiovascular disease in children with chronic kidney disease. Curr Opin Nephrol Hypertens. 2021 Mar 1;30(2):231-236.
Mitsnefes MM. Cardiovascular Disease Risk Factors in Chronic Kidney Disease in Children. Semin Nephrol. 2021 Sep;41(5):434-438.
Atkinson MA, Warady BA. Anemia in chronic kidney disease. Pediatr Nephrol. 2018 Feb;33(2):227-238.
Stahl JL, Wightman AG, Flythe JE, Weiss NS, Hingorani SR, Stoep AV. Psychiatric Diagnoses in Children With CKD Compared to the General Population. Kidney Med. 2022 Mar 18;4(6):100451.
Uauy RD, Hogg RJ, Brewer ED, Reisch JS, Cunningham C, Holliday MA. Dietary protein and growth in infants with chronic renal insufficiency: a report from the Southwest Pediatric Nephrology Study Group and the University of California, San Francisco. Pediatr Nephrol. 1994 Feb;8(1):45-50.
Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet. 1997 Apr 19;349(9059):1117-23.
Mak RH, Iyengar A, Wang AY. Nutrition Management for Chronic Kidney Disease: Differences and Special Needs for Children and Adults. Semin Nephrol. 2023 Jul;43(4):151441.
Madrigal C, Soto-Méndez MJ, Hernández-Ruiz Á, Valero T, Lara Villoslada F, Leis R, Martínez de Victoria E, Moreno JM, Ortega RM, Ruiz-López MD, Varela-Moreiras G, Gil Á. Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study. Nutrients. 2021 Mar 24;13(4):1062.
Cupisti A, Kalantar-Zadeh K. Management of natural and added dietary phosphorus burden in kidney disease. Semin Nephrol. 2013 Mar;33(2):180-90.
Román-Ortiz, Elena & Mendizábal-Oteiza, Santiago & codoñer-franch, Pilar. (2018). Nutrition in Pediatric Kidney Disease. Journal of Child Science. 08. e82-e89. 10.1055/s-0038-1669379.
Health Canada (federal institution of Government of Canada) https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-macronutrients.html
Ludwig DS, Hu FB, Tappy L, Brand-Miller J. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ. 2018 Jun 13;361:k2340. Accessed 04.05.2024.
Clemente-Suárez VJ, Mielgo-Ayuso J, Martín-Rodríguez A, Ramos-Campo DJ, Redondo-Flórez L, Tornero-Aguilera JF. The Burden of Carbohydrates in Health and Disease. Nutrients. 2022 Sep 15;14(18):3809.
Rees L, Shaw V, Qizalbash L, Anderson C, Desloovere A, Greenbaum L, Haffner D, Nelms C, Oosterveld M, Paglialonga F, Polderman N, Renken-Terhaerdt J, Tuokkola J, Warady B, Walle JV, Shroff R; Pediatric Renal Nutrition Taskforce. Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol. 2021 Jan;36(1):187-204.
Heuschkel RB, Gottrand F, Devarajan K, Poole H, Callan J, Dias JA, Karkelis S, Papadopoulou A, Husby S, Ruemmele F, Schäppi MG, Wilschanski M, Lionetti P, Orel R, Tovar J, Thapar N, Vandenplas Y; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):131-41.
Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012 Jun;32 Suppl 2(Suppl 2):S32-86.
Ledermann SE, Spitz L, Moloney J, Rees L, Trompeter RS. Gastrostomy feeding in infants and children on peritoneal dialysis. Pediatr Nephrol. 2002 Apr;17(4):246-50.
von Schnakenburg C, Feneberg R, Plank C, Zimmering M, Arbeiter K, Bald M, Fehrenbach H, Griebel M, Licht C, Konrad M, Timmermann K, Kemper MJ. Percutaneous endoscopic gastrostomy in children on peritoneal dialysis. Perit Dial Int. 2006 Jan-Feb;26(1):69-77.
Krom H, de Winter JP, Kindermann A. Development, prevention, and treatment of feeding tube dependency. Eur J Pediatr. 2017 Jun;176(6):683-688.
Parekh RS, Flynn JT, Smoyer WE, Milne JL, Kershaw DB, Bunchman TE, Sedman AB. Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol. 2001 Nov;12(11):2418-2426.
Saland JM, Pierce CB, Mitsnefes MM, Flynn JT, Goebel J, Kupferman JC, Warady BA, Furth SL; CKiD Investigators. Dyslipidemia in children with chronic kidney disease. Kidney Int. 2010 Dec;78(11):1154-63.
Kouri AM, Rheault MN. Cardiovascular disease in children with chronic kidney disease. Curr Opin Nephrol Hypertens. 2021 Mar 1;30(2):231-236.
Baek HS, Kim SH, Kang HG, Choi HJ, Cheong HI, Ha IS, Han KH, Cho HY, Shin JI, Park YS, Lee JH, Ahn YH, Park E, Cho MH. Dyslipidemia in pediatric CKD patients: results from KNOW-PedCKD (KoreaN cohort study for Outcomes in patients With Pediatric CKD). Pediatr Nephrol. 2020 Aug;35(8):1455-1461.
Saturated fatty acid and trans-fatty acid intake for adults and children: WHO guideline summary; https://iris.who.int/bitstream/handle/10665/375034/9789240083592 eng.pdf?sequence=1&isAllowed=y Accessed 04.05.2024
KDOQI Work Group. KDOQI Clinical Practice Guideline for Nutrition in Children with
CKD: 2008 update. Executive summary. Am J Kidney Dis. 2009 Mar;53(3 Suppl 2):S11-104.
WHO: sodium reduction. https://www.who.int/news-room/fact-sheets/detail/salt-reduction Accessed 04.05.2024.
Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Cleve Clin J Med. 2017 Dec;84(12):934-942.
Janjua H. Management of hyperkalemia in children. Curr Opin Pediatr. 2024 Apr 1;36(2):204-210.
Górska-Warsewicz H, Rejman K, Laskowski W, Kowalcze K. Food Sources of Potassium in the Average Polish Diet. Nutrients. 2019 Dec 1;11(12):2905.
Batista RAB, Japur CC, Prestes IV, Fortunato Silva J, Cavanha M, das Graças Pena G. Potassium reduction in food by preparation technique for the dietetic management of patients with chronic kidney disease: a review. J Hum Nutr Diet. 2021 Aug;34(4):736-746.
McAlister L, Pugh P, Greenbaum L, Haffner D, Rees L, Anderson C, Desloovere A, Nelms C, Oosterveld M, Paglialonga F, Polderman N, Qizalbash L, Renken-Terhaerdt J, Tuokkola J, Warady B, Walle JV, Shaw V, Shroff R. The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis-clinical practice recommendation from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol. 2020 Mar;35(3):501-518.
Mitsnefes MM, Daniels SR, Schwartz SM, Meyer RA, Khoury P, Strife CF. Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol. 2000 Sep;14(10-11):898-902.
Shroff RC, Donald AE, Hiorns MP, Watson A, Feather S, Milford D, Ellins EA, Storry C, Ridout D, Deanfield J, Rees L. Mineral metabolism and vascular damage in children on dialysis. J Am Soc Nephrol. 2007 Nov;18(11):2996-3003.
Étude Individuelle Nationaledes Consommations Alimentaires 2 (INCA 2) 2006-2007 (2009); https://www.anses.fr/fr/system/files/ PASER-Ra-INCA2.pdf. Accessed 04.05.2024.
Hoy MK, Goldman JD (2014) Calcium intake of the U.S. polulation: What We Eat in America, NHANES 2009-2010.; https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/ 13_calcium_intake_0910.pdf. Accessed 04.05.2024.
Plantz MA, Bittar K. Dietary Calcium. [Updated 2022 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549792/
Cupisti A, Kalantar-Zadeh K. Management of natural and added dietary phosphorus burden in kidney disease. Semin Nephrol. 2013 Mar;33(2):180-90.
Shikh EV, Makhova AA, Dorogun OB, Elizarova EV. [The role of phytates in human nutrition]. Vopr Pitan. 2023;92(4):20-28.
Bikle DD. Vitamin D: Production, Metabolism and Mechanisms of Action. [Updated 2021 Dec 31]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278935/
Shroff R, Wan M, Nagler EV, Bakkaloglu S, Fischer DC, Bishop N, Cozzolino M, Bacchetta J, Edefonti A, Stefanidis CJ, Vande Walle J, Haffner D, Klaus G, Schmitt CP; European Society for Paediatric Nephrology Chronic Kidney Disease Mineral and Bone Disorders and Dialysis Working Groups. Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2-5 and on dialysis. Nephrol Dial Transplant. 2017 Jul 1;32(7):1098-1113.
Shroff R, Wan M, Nagler EV, Bakkaloglu S, Cozzolino M, Bacchetta J, Edefonti A, Stefanidis CJ, Vande Walle J, Ariceta G, Klaus G, Haffner D, Schmitt CP; European Society for Paediatric Nephrology Chronic Kidney Disease Mineral and Bone Disorders and Dialysis Working Groups. Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2-5 and on dialysis. Nephrol Dial Transplant. 2017 Jul 1;32(7):1114-1127.
Shroff R, Wan M, Gullett A, Ledermann S, Shute R, Knott C, Wells D, Aitkenhead H, Manickavasagar B, van't Hoff W, Rees L. Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial. Clin J Am Soc Nephrol. 2012 Feb;7(2):216-23.
Kari JA, Baghdadi OT, El-Desoky S. Is high-dose cholecalciferol justified in children with chronic kidney disease who failed low-dose maintenance therapy? Pediatr Nephrol. 2013 Jun;28(6):933-7.59. Kari JA, El Desoky SM, El-Morshedy SM, Habib HS. Vitamin D insufficiency and deficiency in children with chronic kidney disease. Ann Saudi Med. 2012 Sep-Oct;32(5):473-8.
Hari P, Gupta N, Hari S, Gulati A, Mahajan P, Bagga A. Vitamin D insufficiency and effect of cholecalciferol in children with chronic kidney disease. Pediatr Nephrol. 2010 Dec;25(12):2483-8.
Nadeem S, Tangpricha V, Ziegler TR, Rhodes JE, Leong T, Xiang Y, Greenbaum LA. Randomized trial of two maintenance doses of vitamin D in children with chronic kidney disease. Pediatr Nephrol. 2022 Feb;37(2):415-422.
Hahn D, Hodson EM, Craig JC. Interventions for metabolic bone disease in children with
chronic kidney disease. Cochrane Database Syst Rev. 2015 Nov 12;2015(11):CD008327.
Salusky IB, Kuizon BD, Belin TR, Ramirez JA, Gales B, Segre GV, Goodman WG. Intermittent calcitriol therapy in secondary hyperparathyroidism: a comparison between oral and intraperitoneal administration. Kidney Int. 1998 Sep;54(3):907-14.
Ardissino G, Schmitt CP, Bianchi ML, Daccò V, Claris-Appiani A, Mehls O. No difference in intestinal strontium absorption after oral or IV calcitriol in children with secondary hyperparathyroidism. The European Study Group on Vitamin D in Children with Renal Failure. Kidney Int. 2000 Sep;58(3):981-8.
Jones CL, Vieth R, Spino M, Ledermann S, Kooh SW, Balfe J, Balfe JW. Comparisons between oral and intraperitoneal 1,25-dihydroxyvitamin D3 therapy in children treated with peritoneal dialysis. Clin Nephrol. 1994 Jul;42(1):44-9.
Escobedo-Monge MF, Ayala-Macedo G, Sakihara G, Peralta S, Almaraz-Gómez A, Barrado E, Marugán-Miguelsanz JM. Effects of Zinc Supplementation on Nutritional Status in Children with Chronic Kidney Disease: A Randomized Trial. Nutrients. 2019 Nov 5;11(11):2671.
Hamedi-Kalajahi F, Imani H, Mojtahedi S, Shabbidar S. Effect of L-Carnitine Supplementation on Inflammatory Markers and Serum Glucose in Hemodialysis Children: A Randomized, Placebo-Controlled Clinical Trial. J Ren Nutr. 2022 Mar;32(2):144-151.
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