Nutrition and Growth in Children with Chronic Kidney Disease

Providing optimal nutrition is a vital aspect in the care of children with chronic kidney disease (CKD). The goals of therapeutic nutritional management in the pediatric CKD population are to maintain adequate dietary intake to meet calorie and protein needs for optimal growth, while avoiding electrolyte abnormalities, uremic toxicity, malnutrition, and other nutrition-associated comorbidities. The association between poor linear growth and malnutrition with increased risk of mortality in children with CKD highlights the importance of accurate nutritional assessment and early intervention to ensure adequate nutrition in this patient population. The nutritional assessment of children with CKD is complicated by their altered body composition, which is characterized by reduced lean mass, abnormal fat distribution patterns, and short stature. Therefore, careful assessment, monitoring, and management of nutritional status in children with CKD are essential for optimizing growth and development, especially in younger children. This research topic will first provide a historical perspective on nutrition and growth in children with CKD over the years. Current research on the contribution of appetite dysregulation to protein energy wasting and impaired growth in children with CKD will then be reviewed. Nutritional management in CKD and end stage renal disease patients will be discussed, including current practices in enteral and parenteral support. Furthermore, strategies to assess and optimize nutritional status and bone health in this population will be reviewed. Future directions in this area should include more randomized trials to establish evidence-based guidelines for nutritional assessment and management in pediatric CKD.