Targeted Nutritional Management for Children With Chronic Kidney Disease

The Kidney Disease Improving Global Outcomes (KDIGO) 2024 defined the chronic kidney disease as abnormalities of kidney structure or function, present for a minimum of 3 months, with implications for health. CKD is classified based on Cause, Glomerular filtration rate (GFR) category (G1-G5), and Albuminuria category (A1-A3).

Nutritional management of pediatric patients with kidney disease is challenging as they undergo continued growth and development. So providing adequate nutrition for growth while minimizing disease progression and complications is the primary challenge.

There are many reasons for poor growth in children with (CKD), One of the most important of these is inadequate nutritional intake which may be due to anorexia, which is common in CKD, gastro-esophageal reflux with recurrent vomiting. The consequences of poor nutrition in children are suboptimal growth and impaired achievement of final height potential, abnormal body composition, developmental delay, a worsening of uremic symptoms such as vomiting, protein-energy wasting, and increased mortality.

optimizing the dietary prescription for the child with CKD is of vital importance at any age to promote growth and reverse growth failure if present.

During progression of chronic kidney disease, the requirements and utilization of different nutrients change significantly. These changes ultimately place patients with kidney disease at higher risk for nutritional and metabolic abnormalities so regular assessment of nutritional status and provision of suitable nutrition are key parts in the overall management of children with CKD aiming at preventing protein-energy malnutrition, meeting the patient's micronutrients needs and preventing overnutrition and the long-term implications of an undesirable eating routine.

unbalanced dietary pattern, characterized by high animal protein content: may worsen metabolic control, accelerate renal deterioration and consequently aggravate the stage of the chronic kidney disease in pediatric patients.

CKD is associated with chronic low-grade inflammation causing catabolic destruction of structural and functional proteins, resulting in skeletal muscle wasting, leading to progressive weight loss, muscle weakness in children resulting in a decrease in functional capacity.

Patients with advanced CKD are at high risk of cardiovascular disease (CVD). Complex changes in both the cardiac and vascular systems results in structural and functional changes that can lead to reduced exercise tolerance, quality of life and ultimately premature death.

A multidisciplinary team should consistently communicate the same messages about nutrition to provide support to the family. Educational resources, whether verbal, written, pictorial, or digital, must be adapted to suit the learning style of the child and family so that they understand the need for any nutritional interventions. This understanding, in turn, will lead to better adherence and improved outcomes for the child with CKD.