Thematic Area: Nutrition

Experts Recommendations

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