Thematic Area: Nutrition

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