Nutritional management of the child with kidney disease

Document Type

Book Chapter

Publication Date

2022

Identifier

DOI: 10.1016/B978-0-12-818540-7.00030-6

Abstract

Children with advanced chronic kidney disease (CKD) or end-stage kidney disease are at risk for protein–energy malnutrition (PEM), as well as overweight and obesity, outcomes that contribute to an increased risk for morbidity and mortality. While PEM is associated with an appropriate physiological adaptive response to negative energy balance that is usually reversible by restoring adequate nutritional intake, overweight and obesity is emerging as a greater problem than undernutrition, especially in children receiving peritoneal dialysis who also receive aggressive enteral nutritional support. Successful management of nutritional issues in children with CKD starts with periodic and meticulous assessments of nutritional status by providers with a thorough knowledge of both normal pediatric nutritional requirements and nutritional disturbances commonly seen in children with CKD or on maintenance dialysis. Attention to the unique nutritional requirements of infants, children, and adolescents, and consideration of the patient’s food preferences are essential aspects of the nutritional management plan. Dietary restrictions in children should be limited, and restrictions of nutrients should be imposed only when there is a clear indication, rather than an anticipated need. While oral supplementation is preferred when inadequate dietary intake is complicated by poor growth or weight gain, enteral nutritional support with nasogastric tube/gastrostomy button should be included as a key aspect of the treatment strategy when the nutritional goals cannot be met by the oral route alone.

Journal Title

Nutritional Management of Renal Disease (Fourth Edition)

First Page

629

Last Page

657

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