NEW YORK—The National Kidney Foundation has updated its nutrition clinical practice guidelines for children with chronic kidney disease.
The guideline updates and expands the pediatric recommendations of the 2000 Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Nutrition in Chronic Renal Failure.
The National Kidney Foundation’s “KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008” was published March 5 as a supplement to the American Journal of Kidney Diseases.
The guideline is available online in its entirety at www.kdoqi.org.
Among the revisions from the previous guideline are recommendations concerning the dietary intake of sodium, potassium, calcium, phosphorus, and fat in children with CKD. The update also provides new information on the diagnosis and management of nutritional issues in children with CKD and new benchmarks for evaluating growth.
“A review of the literature published in the last eight years found substantial new evidence concerning the evaluation and management of nutritional parameters in children,” said KDOQI Chair Michael Rocco, MD, MSCE. “The effect of nutrition is especially important in children because of its impact on growth and development.”
According to Donna Secker, PhD, RD, one of the two co-chairs of the work group, “The guideline offers recommendations for evaluating nutritional status and growth and providing nutritional counseling and management, including therapeutic interventions such as enteral (tube) feeding, intradialytic parenteral nutrition, growth hormone therapy, and restriction or supplementation of various macro- and micronutrients.”
The new guidelines also provide reference material to help with implementation, including new growth charts from the World Health Organization, tables of food and formula nutrient content, and a list of available electronic tools for quick calculation of energy requirements, midparental height and anthropometric z scores.
Key topics included in the guideline:
- Evaluation of Growth and Nutritional Status
- Growth
- Nutrition Management and Counseling
- Energy Requirements and Therapy
- Protein Requirements and Therapy
- Vitamin and Trace Elements
- Requirements and Therapy
- Bone and Mineral and Vitamin D Requirements and Therapy
- Fluid and Electrolyte Requirements and Therapy
- Carnitine
- Nutritional Management of Transplant Patients
"The guideline is intended to assist the practitioner caring for infants, children and adolescents with CKD stages 2-5, on long-term dialysis or with a kidney transplant,” said Bradley Warady, MD, work group co-chair. “The recommendations for nutritional management are essential to the well being of these children, and specifically emphasize the relationship between nutritional status and the risk of cardiovascular disease.”
