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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
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
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
Calcium and Phosphate: Refer to CKD-MBD Guideline
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