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

Nelms, Christina L.

doi:10.3389/fped.2018.00214

Cited by 18 publications

(18 citation statements)

References 62 publications

(117 reference statements)

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“…Low BMI prior to transplant was significantly and independently associated with FTT at 1 year post‐transplant, but did not persist at 3 years post‐transplant. Pre‐transplant factors such as inadequate nutritional intake related to poor appetite, feeding intolerance due to delayed gastric motility and emesis, delayed oral motor skills and aversions are known to contribute to negative energy balance and poor weight gain in children with ESRD prior to transplant . In addition, dialysis‐related nutrient losses of protein, water‐soluble vitamins, minerals such as zinc, and carnitine deficiency also contribute to malnutrition, poor growth, and muscle weakness .…”

Section: Discussionmentioning

confidence: 99%

“…Pre‐transplant factors such as inadequate nutritional intake related to poor appetite, feeding intolerance due to delayed gastric motility and emesis, delayed oral motor skills and aversions are known to contribute to negative energy balance and poor weight gain in children with ESRD prior to transplant . In addition, dialysis‐related nutrient losses of protein, water‐soluble vitamins, minerals such as zinc, and carnitine deficiency also contribute to malnutrition, poor growth, and muscle weakness . Some of these effects may persist in the early post‐transplant period, and those with a low BMI prior to transplant may require a longer period of time to develop oral feeding skills and replete their macro and micro nutrient stores to promote improved weight gain after transplant.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation

Sgambat

Cheng

Charnaya

et al. 2018

Pediatric Transplantation

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Background Prior to transplantation, effects of advanced CKD contribute to malnutrition and impaired growth. After transplant, children are expected to thrive, however, in a subset of transplant recipients this does not occur. Factors associated with post‐transplant FTT are poorly understood. Objective A retrospective cohort study was conducted to determine factors associated with FTT and association of FTT with infections and hospitalizations. Methods Records of 119 children transplanted between 2005 and 2016 were reviewed. FTT was defined by ≥2 of the following post‐transplant criteria: (a) low BMI or deceleration in BMI z‐score, (b) poor growth velocity, and (c) chronic hypoalbuminemia at 1 or 3 years post‐transplant. Association of FTT with deceased donor transplant, de novo DSA, intolerance to MMF, anemia, vitamin D deficiency, and CIC was investigated by logistic regression. Poisson regression was used to identify outcomes associated with FTT. Results Low pre‐transplant BMI and post‐transplant CIC dependence were independently associated with FTT after transplant. Odds of FTT at 1 year post‐transplant decreased by 0.5 for each 1 unit increase in pre‐transplant BMI z‐score. Requirement for CIC conferred 3.8 and 7.8 higher odds of FTT at 1 and 3 years. Patients with FTT had 2.7 and 2.6 times infections and hospitalizations during the first year, and 4.2 and 4.3 times infections and hospitalizations over 3 years post‐transplant. Conclusions Children with low BMI prior to transplant and those requiring CIC after transplant are at increased risk for post‐transplant FTT. FTT is associated with adverse outcomes, evidenced by increased infections and hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation

Sgambat

Cheng

Charnaya

et al. 2018

Pediatric Transplantation

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“…Nutritional management was based on published guidelines and our pediatric renal nutrition specialist (22, 23). Nutritional aims were to provide 100% of estimated nutrient requirements for energy and supplemental protein as indicated for dialysis losses.…”

Section: Methodsmentioning

confidence: 99%

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

et al. 2019

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Recent advances in the early diagnosis of fetal CAKUT with an increase in fetal surgical interventions have led to a growing number of neonatal survivors born with severe renal dysfunction. This, in turn, has required the development of multi-disciplinary treatment paradigms in the individualized management of these infants with advanced stage kidney disease from birth. Early multi-modal management includes neonatal surgical interventions directed toward establishing adequate urine flow, respiratory support with the assessment of pulmonary hypoplasia, and establishing metabolic control to avoid the need for dialysis intervention. The development of specialized imaging to assess for residual renal mass with non-invasive 3-dimensional techniques are rapidly evolving. The use of non-radioactive imaging offers improved safety and allows for early prognostic-based planning including anticipatory guidance for progression to end stage renal disease (ESRD). The trajectory of kidney function during the neonatal period as determined by peak and nadir serum creatinine (SCr) and cystatin C (CysC) during the first months of life provides a guide toward individualized prospective management. This is a single center experience based on a birth cohort of 42 subjects followed prospectively from birth for an average of 6.1 ± 2.8 years at the University of Miami/Holtz Children's Hospital during the past decade. There was an 8:1 male: female ratio. The birth cohort was divided into 3 subgroups according to CKD Stages at the current age: CKD 1–2 (Group 1) (eGFR ≥ 60 ml/min/1.73 m 2 ) ( N = 15), CKD stage 3–5 (Group 2) (eGFR ≤ 59 ml/min/1.73 m 2 ) ( N = 12), and ESRD—Dialysis and/or Transplantation (Group 3) ( N = 15). A neonatal CysC >3.0 mg/L predicted progression to ESRD while a nadir SCr >0.6 mg/dL predicted progression to CKD 3–5 with the highest specificity and sensitivity by ROC-AUC analysis ( P < 0.0001). Medical management was directed toward nutritional support with novel formula designs, early introduction of growth hormone and strict control of mineral bone disorder. One of the central aspects of the management was to avoid dialysis for as long as feasible with a primary goal toward pre-emptive transplantation.

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“…La restriction en phosphates consiste en l'éviction d'aliments riches en protéines. Les aliments sources de phosphates sont généralement ceux qui contiennent du calcium, ce qui nécessite la mise en place d'une supplémentation calcique [50,51].…”

Section: Nutritionunclassified

“…Le lait maternel, tout comme pour les autres enfants, est le lait le plus adapté pour l'enfant en dialyse et doit être privilégié et encouragé si possible. Pour les enfants plus grands, différents types de produits peuvent être utilisés et ont fait l'objet d'une revue détaillée [51]. Certains sont spécifiquement développés pour l'enfant en insuffisance rénale ou en DP (Renastart®, Renacal®, Kindergen®, etc.…”

Section: Nutritionunclassified

Growth and nutritional management of children on peritoneal dialysis

2019

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Stunting and malnutrition are common in children with chronic kidney disease and increase with the degree of impairment to be maximal in children at the dialysis stage, leading to a risk of excess mortality. Despite many advances in the field of pediatric dialysis, small size in adulthood remains very common in this population. The origin of malnutrition and stunting is complex and multifactorial. In infants on peritoneal dialysis, insufficient nutritional intake is recognized as a major barrier to adequate growth. The diagnostic approach to undernutrition and stunting in peritoneal dialysis requires the use of several elements: an interrogation, a clinical examination, and various complementary examinations. Due to the multifactorial aspect of the nutritional and statural status of the child, several therapeutic axes are to be taken into account, namely a nutritional treatment adapted to the needs of the child, a treatment by growth hormone, and an optimization of dialysis to allow optimal metabolic control.

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

Cited by 18 publications

References 62 publications

The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation

The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

Growth and nutritional management of children on peritoneal dialysis

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