Thematic Area: Nutrition

The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease – Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce

Reference: Desloovere A, Polderman N, Renken-Terhaerdt J, et al. The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce. J Ren Nutr. 2025;35(1):207-220. doi:10.1053/j.jrn.2024.05.008

 This clinical practice recommendation was reviewed and evaluated by ERKNet experts using the AGREE-II methodology. Following this assessment, the ERKNet Network Board officially endorsed the guideline and committed to implementing its recommendations in clinical practice.

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

Reference: McAlister L, Pugh P, Greenbaum L, et al. Pediatr Nephrol. (2020). doi: 10.1007/s00467-019-04370-z

KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update

Reference: KDOQI Work Group. Am J Kidney Dis. (2009). doi:10.1053/j.ajkd.2008.11.017

Core Recommendations:  

1. Energy requirements:
   - Provide 100% estimated energy requirements for chronological age.
   -  Individually adjust for physical activity level & body size
   -  Adjust energy intake based upon the response in rate of weight gain or loss 
2. Protein requirements:
   - In CKD Stage 3 provide 100% - 140% Dietary Reference Intake (DRI ) for ideal body weight
   - In CKD Stage 4 – 5 provide  100% - 120% DRI for ideal body weight
   - In HD patients provide DRI + 0.1g/kg/day to compensate for dialytic losses
   - In PD patients provide DRI + 0.15 – 0.3g/kg/day depending on age and to compensate for peritoneal losses 
3. Vitamins and Minerals:
   - Provide 100% DRI for most vitamins eg B1, B2, B3, B6, , B12, biotin, pantothenic acid, folic acid, C,A,E & K
   - Provide 100% DRI for copper & zinc
   - Supplementation if <100%DRI or clinical evidence of deficiency
   - Supplementation of water soluble vitamins in CKD stage 5D
4. Calcium and Phosphate:
        Refer to CKD-MBD Guideline
5.  Electrolytes:
   - Sodium supplementation may be required in polyuric children
   - Sodium restriction may be required in oligoanuric children or those with polyuria
   - Potassium – limit intake limited in children who have or are at risk of hyperkalaemia

Comments by evaluators:

• Lack of published data on nutrition in all stages of CKD, so low quality of evidence - small sample sizes, the lack of RCTs, limited information on clinical outcomes