Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

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Abstract

In children with kidney diseases, an assessment of the child’s growth and nutritional status is important to guide the dietary prescription. No single metric can comprehensively describe the nutrition status; therefore, a series of indices and tools are required for evaluation. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. Herein, we present CPRs for nutritional assessment, including measurement of anthropometric and biochemical parameters and evaluation of dietary intake. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Audit and research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00467-020-04852-5.

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A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

Tanis R Fenton, Jae Kim (2013)

Background The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Methods Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Results Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. Conclusions The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.

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A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease.

D. Fouque, K. Kalantar-Zadeh, J Kopple … (2008)

The recent research findings concerning syndromes of muscle wasting, malnutrition, and inflammation in individuals with chronic kidney disease (CKD) or acute kidney injury (AKI) have led to a need for new terminology. To address this need, the International Society of Renal Nutrition and Metabolism (ISRNM) convened an expert panel to review and develop standard terminologies and definitions related to wasting, cachexia, malnutrition, and inflammation in CKD and AKI. The ISRNM expert panel recommends the term 'protein-energy wasting' for loss of body protein mass and fuel reserves. 'Kidney disease wasting' refers to the occurrence of protein-energy wasting in CKD or AKI regardless of the cause. Cachexia is a severe form of protein-energy wasting that occurs infrequently in kidney disease. Protein-energy wasting is diagnosed if three characteristics are present (low serum levels of albumin, transthyretin, or cholesterol), reduced body mass (low or reduced body or fat mass or weight loss with reduced intake of protein and energy), and reduced muscle mass (muscle wasting or sarcopenia, reduced mid-arm muscle circumference). The kidney disease wasting is divided into two main categories of CKD- and AKI-associated protein-energy wasting. Measures of chronic inflammation or other developing tests can be useful clues for the existence of protein-energy wasting but do not define protein-energy wasting. Clinical staging and potential treatment strategies for protein-energy wasting are to be developed in the future.

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Measurement of dietary intake in children.

M Livingstone, P Robson (2000)

When children and adolescents are the target population in dietary surveys many different respondent and observer considerations surface. The cognitive abilities required to self-report food intake include an adequately developed concept of time, a good memory and attention span, and a knowledge of the names of foods. From the age of 8 years there is a rapid increase in the ability of children to self-report food intake. However, while cognitive abilities should be fully developed by adolescence, issues of motivation and body image may hinder willingness to report. Ten validation studies of energy intake data have demonstrated that mis-reporting, usually in the direction of under-reporting, is likely. Patterns of under-reporting vary with age, and are influenced by weight status and the dietary survey method used. Furthermore, evidence for the existence of subject-specific responding in dietary assessment challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Unfortunately, the ability to detect mis-reporters, by comparison with presumed energy requirements, is limited unless detailed activity information is available to allow the energy intake of each subject to be evaluated individually. In addition, high variability in nutrient intakes implies that, if intakes are valid, prolonged dietary recording will be required to rank children correctly for distribution analysis. Future research should focus on refining dietary survey methods to make them more sensitive to different ages and cognitive abilities. The development of improved techniques for identification of mis-reporters and investigation of the issue of differential reporting of foods should also be given priority.

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Author and article information

Contributors

Rukshana Shroff:

ORCID: http://orcid.org/0000-0001-8501-1072

Rukshana.Shroff@gosh.nhs.uk

Journal

Journal ID (nlm-ta): Pediatr Nephrol

Journal ID (iso-abbrev): Pediatr Nephrol

Title: Pediatric Nephrology (Berlin, Germany)

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0931-041X

ISSN (Electronic): 1432-198X

Publication date (Electronic): 14 December 2020

Publication date PMC-release: 14 December 2020

Publication date (Print): 2021

Volume: 36

Issue: 4

Pages: 995-1010

Affiliations

[1 ]GRID grid.266814.f, ISNI 0000 0004 0386 5405, University of Nebraska, ; Kearney, NE USA

[2 ]GRID grid.83440.3b, ISNI 0000000121901201, University College London Great Ormond Street Hospital Institute of Child Health, ; London, WC1N 3JH UK

[3 ]GRID grid.11201.33, ISNI 0000 0001 2219 0747, University of Plymouth, ; Plymouth, UK

[4 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Emory University, ; Atlanta, GA USA

[5 ]GRID grid.428158.2, ISNI 0000 0004 0371 6071, Children’s Healthcare of Atlanta, ; Atlanta, GA USA

[6 ]GRID grid.430506.4, University Hospital Southampton NHS Foundation Trust, ; Southampton, UK

[7 ]GRID grid.410566.0, ISNI 0000 0004 0626 3303, University Hospital Ghent, ; Ghent, Belgium

[8 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Children’s Hospital, , Hannover Medical School, ; Hannover, Germany

[9 ]GRID grid.414503.7, ISNI 0000 0004 0529 2508, Emma Children’s Hospital, , Amsterdam University Medical Center, ; Amsterdam, The Netherlands

[10 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ; Milan, Italy

[11 ]GRID grid.414137.4, ISNI 0000 0001 0684 7788, British Columbia Children’s Hospital, ; Vancouver, Canada

[12 ]Great Northern Children’s Hospital, Newcastle upon Tyne, UK

[13 ]GRID grid.7692.a, ISNI 0000000090126352, Wilhelmina Children’s Hospital, , University Medical Center Utrecht, ; Utrecht, The Netherlands

[14 ]GRID grid.7737.4, ISNI 0000 0004 0410 2071, Children’s Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, , University of Helsinki and Helsinki University Hospital, ; Helsinki, Finland

[15 ]GRID grid.239559.1, ISNI 0000 0004 0415 5050, Children’s Mercy Kansas City, ; Kansas City, MO USA

Author information

Rukshana Shroff http://orcid.org/0000-0001-8501-1072

Article

Publisher ID: 4852

DOI: 10.1007/s00467-020-04852-5

PMC ID: 7910229

PubMed ID: 33319327

SO-VID: 96b05ea4-f56d-43c4-87f6-7b40984da7ff

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 May 2020

Date revision received : 3 October 2020

Date accepted : 6 November 2020

Funding

Funded by: University College London (UCL)

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: assessment,children,kidney diseases,nutrition,clinical practice recommendations,pediatric renal nutrition taskforce

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ScienceOpen disciplines: Nephrology

Keywords: assessment, children, kidney diseases, nutrition, clinical practice recommendations, pediatric renal nutrition taskforce

Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

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Abstract

Supplementary Information

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 101

A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease.

Measurement of dietary intake in children.

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