Nutritional management of children with chronic renal failure

Hellerstein, Stanley; Holliday, Malcolm A.; Grupe, Warren E.; Fine, Richard Ν.; Fennell, Robert S.; Chesney, Russell W.; Chan, James C.M.

doi:10.1007/bf00849294

Cited by 45 publications

(9 citation statements)

References 133 publications

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“…In turn, while we do not feel that all pediatric patients receiving peritoneal dialysis should be evaluated for carnitine deficiency, we agree with a recent task force report that plasma carnitine levels should be obtained and that supplementation should be considered when symptoms such as severe muscle weak ness or cardiomyopathy arise in this setting [36].…”

Section: Discussionsupporting

confidence: 63%

Carnitine Status of Pediatric Patients on Continuous Ambulatory Peritoneal Dialysis

et al. 1990

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Plasma carnitine and the effect of oral carnitine supplementation on serum triglycerides was studied in 12 pediatric patients receiving continuous ambulatory peritoneal dialysis (CAPD). Baseline evalution of all patients included plasma carnitine and serum triglyceride values. Following randomization into two groups, only group 2 patients received oral L-carnitine supplementation, 100 mg/kg/day, for 2 months. The initial laboratory evaluation was repeated at the conclusion of the study. Plasma carnitine values were also determined from a control population. Mean baseline plasma carnitine concentrations of group 1 (39.8 ± 8.0 nmol/ml) and group 2 (45.2 ± 10.3nmol/ml) patients were not significantly different from each other or from the control population. Serum triglyceride values were elevated in both groups (group 1 – 206.5 ± 100.0 mg/dl; group 2 – 279.3 ± 74.5 mg/dl). After 2 months, the mean plasma carnitine concentration of group 2 patients increased to 147.7 ± 84.1 nmol/ml, significantly greater than the value of group 1, 32.8 ± 8.0 nmol/ml (p < 0.004). However, no significant change in the serum triglyceride level was noted in either group. We conclude that the plasma carnitine status of pediatric patients receiving CAPD is normal and that oral carnitine supplementation does not lead to the resolution of hypertriglyceridemia.

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Section: Discussionsupporting

confidence: 63%

Carnitine Status of Pediatric Patients on Continuous Ambulatory Peritoneal Dialysis

et al. 1990

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“…However, the feed contributed less than the previously recommended 8% of energy derived from protein [18]. Although the percentage protein energy from the feed fell significantly in the 0 to 2-years group, this reflects an increasing energy intake rather than a decrease in protein intake.…”

Section: Discussionmentioning

confidence: 69%

Long-term enteral nutrition in infants and young children with chronic renal failure

Ledermann

Shaw

Trompeter

1999

Pediatric Nephrology

113

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An inadequate nutritional intake is common in infants and young children with chronic and end-stage renal failure (CRF/ESRF), causing poor weight gain and growth retardation. In a programme of enteral feeding (EF), growth, nutritional intake and outcome for oral feeding were evaluated in 35 children with CRF/ESRF, mean (range) age 1.6 (0-4.9) years at start of EF for 30 (12-60) months. Twenty-nine had a glomerular filtration rate of 12.1 (6-26) ml/min per 1.73 m(2) and 6 were on peritoneal dialysis. Mean (SD) weight standard deviation scores (SDSs) in the 0 to 2-year age group (n=26) were -3.3 (1.0) 6 months before EF, -3.1 (1.3) at the start, -1.7 (1. 4) at 1 year, (P=0.0003) and -1.4 (1.8) at 2 years, (P=0.0008). Height SDSs were -2.9 (0.7), -2.9 (1.2), -2.2 (1.2) (P=0.008) and -2. 1 (1.3) (P=0.004). Weight SDSs in the 2 to 5-year age group (n=9) were -2.3 (1.2), -2.0 (1.1), -1.1 (1.3) (P=0.002) and -0.9 (1.0) (P=0.04). Height SDSs were -2.8 (0.6), -2.3 (0.7), -2.0 (0.7) and -2. 0 (0.8). There was no change in energy intake as a percentage of the estimated average requirement, nor was this exceeded. Percentage energy from the EF in the 0 to 2 year age group remained unchanged despite an absolute increase in energy intake with age. Twenty-one have had renal transplants, of whom 86% eat and drink normally. Long-term EF prevents or reverses weight loss and growth retardation in children with CRF/ESRF, with the achievement of significant catch-up growth if started before age 2 years.

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“…Despite the unpalatable diets, most of the patients require a phosphate binder in order to counteract hyperphosphatemia. Calcium carbonate and calcium citrate bind the phosphate of the diet and serve as coadjutants in the supply of calcium requirements in the diet [134]. The recommended starting dose for calcium carbonate is 10–20 mg of elemental calcium per kilogram per day with subsequent increasing doses according to the observed levels of serum phosphate.…”

Section: Treatmentmentioning

confidence: 99%

“…However, discordant results in advanced renal failure have been presented by Uauy et al [133]who showed lack of any beneficial effects of a low-protein diet in ameliorating the progression of renal insufficiency. It is recommended that children with significant renal functional compromise should ingest a diet with 8% of calories derived from protein, 50–70% of this with a high biological value [128, 134]. High-calorie/low-protein supplements and low-protein foods like pasta and bread may be useful as adjunctive therapy [2].…”

Section: Treatmentmentioning

confidence: 99%