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      Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis

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          Abstract

          Background

          Adequate calcium (Ca) intake is required for bone mineralization in children. We assessed Ca intake from diet and medications in children with CKD stages 4–5 and on dialysis (CKD4–5D) and age-matched controls, comparing with the UK Reference Nutrient Intake (RNI) and international recommendations.

          Methods

          Three-day prospective diet diaries were recorded in 23 children with CKD4–5, 23 with CKD5D, and 27 controls. Doses of phosphate (P) binders and Ca supplements were recorded.

          Results

          Median dietary Ca intake in CKD4–5D was 480 (interquartile range (IQR) 300–621) vs 724 (IQR 575–852) mg/day in controls ( p = 0.00002), providing 81% vs 108% RNI ( p = 0.002). Seventy-six percent of patients received < 100% RNI. In CKD4–5D, 40% dietary Ca was provided from dairy foods vs 56% in controls. Eighty percent of CKD4–5D children were prescribed Ca-based P-binders, 15% Ca supplements, and 9% both medications, increasing median daily Ca intake to 1145 (IQR 665–1649) mg/day; 177% RNI. Considering the total daily Ca intake from diet and medications, 15% received < 100% RNI, 44% 100–200% RNI, and 41% > 200% RNI. Three children (6%) exceeded the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) upper limit of 2500 mg/day. None with a total Ca intake < RNI was hypocalcemic, and only one having > 2 × RNI was hypercalcemic.

          Conclusions

          Seventy-six percent of children with CKD4–5D had a dietary Ca intake < 100% RNI. Restriction of dairy foods as part of a P-controlled diet limits Ca intake. Additional Ca from medications is required to meet the KDOQI guideline of 100–200% normal recommended Ca intake.

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          Electronic supplementary material

          The online version of this article (10.1007/s00467-020-04571-x) contains supplementary material, which is available to authorized users.

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          Most cited references35

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          Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters

          Linda McCann, Sharon Moe, Rukshana Shroff … (2017)
          The KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD represents a selective update of the prior CKD-MBD Guideline published in 2009. This update, along with the 2009 publication, is intended to assist the practitioner caring for adults and children with chronic kidney disease (CKD), those on chronic dialysis therapy, or individuals with a kidney transplant. This review highlights key aspects of the 2017 CKD-MBD Guideline Update, with an emphasis on the rationale for the changes made to the original guideline document. Topic areas encompassing updated recommendations include diagnosis of bone abnormalities in CKD-mineral and bone disorder (MBD), treatment of CKD-MBD by targeting phosphate lowering and calcium maintenance, treatment of abnormalities in parathyroid hormone in CKD-MBD, treatment of bone abnormalities by antiresorptives and other osteoporosis therapies, and evaluation and treatment of kidney transplant bone disease.
          Article 0 comments Cited 205 times – based on 0 reviews     Review now
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            Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass.

            Adam DG Baxter-Jones, Robert A Faulkner, Mark R Forwood … (2011)
            Bone area (BA) and bone mineral content (BMC) were measured from childhood to young adulthood at the total body (TB), lumbar spine (LS), total hip (TH), and femoral neck (FN). BA and BMC values were expressed as a percentage of young-adult values to determine if and when values reached a plateau. Data were aligned on biological ages [years from peak height velocity (PHV)] to control for maturity. TB BA increased significantly from -4 to +4 years from PHV, with TB BMC reaching a plateau, on average, 2 years later at +6 years from PHV (equates to 18 and 20 years of age in girls and boys, respectively). LS BA increased significantly from -4 years from PHV to +3 years from PHV, whereas LS BMC increased until +4 from PHV. FN BA increased between -4 and +1 years from PHV, with FN BMC reaching a plateau, on average, 1 year later at +2 years from PHV. In the circumpubertal years (-2 to +2 years from PHV): 39% of the young-adult BMC was accrued at the TB in both males and females; 43% and 46% was accrued in males and females at the LS and TH, respectively; 33% (males and females) was accrued at the FN. In summary, we provide strong evidence that BA plateaus 1 to 2 years earlier than BMC. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. The data substantiate the importance of the circumpubertal years for accruing bone mineral. Copyright © 2011 American Society for Bone and Mineral Research.
            Article 0 comments Cited 185 times – based on 0 reviews     Review now
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              Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.

              Marion L. Greaser, B Gales, J.-G. Yoon … (2000)
              Cardiovascular disease is common in older adults with end-stage renal disease who are undergoing regular dialysis, but little is known about the prevalence and extent of cardiovascular disease in children and young adults with end-stage renal disease. We used electron-beam computed tomography (CT) to screen for coronary-artery calcification in 39 young patients with end-stage renal disease who were undergoing dialysis (mean [+/-SD] age, 19+/-7 years; range, 7 to 30) and 60 normal subjects 20 to 30 years of age. In those with evidence of calcification on CT scanning, we determined its extent. The results were correlated with the patients' clinical characteristics, serum calcium and phosphorus concentrations, and other biochemical variables. None of the 23 patients who were younger than 20 years of age had evidence of coronary-artery calcification, but it was present in 14 of the 16 patients who were 20 to 30 years old. Among those with calcification, the mean calcification score was 1157+/-1996, and the median score was 297. By contrast, only 3 of the 60 normal subjects had calcification. As compared with the patients without coronary-artery calcification, those with calcification were older (26+/-3 vs. 15+/-5 years, P<0.001) and had been undergoing dialysis for a longer period (14+/-5 vs. 4+/-4 years, P< 0.001). The mean serum phosphorus concentration, the mean calcium-phosphorus ion product in serum, and the daily intake of calcium were higher among the patients with coronary-artery calcification. Among 10 patients with calcification who underwent follow-up CT scanning, the calcification score nearly doubled (from 125+/-104 to 249+/-216, P=0.02) over a mean period of 20+/-3 months. Coronary-artery calcification is common and progressive in young adults with end-stage renal disease who are undergoing dialysis.
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                Author and article information

                Contributors
                Rukshana Shroff:
                ORCID: https://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): 8 May 2020
                Publication date PMC-release: 8 May 2020
                Publication date (Print): 2020
                Volume: 35
                Issue: 10
                Pages: 1915-1923
                Affiliations
                [1 ]GRID grid.424537.3, ISNI 0000 0004 5902 9895, Great Ormond Street Hospital for Children NHS Foundation Trust, ; London, WC1N 3JH UK
                [2 ]GRID grid.83440.3b, ISNI 0000000121901201, University College London Institute of Child Health, ; London, UK
                [3 ]GRID grid.11201.33, ISNI 0000 0001 2219 0747, University of Plymouth, ; Plymouth, UK
                Author information
                https://orcid.org/0000-0001-8501-1072
                Article
                Publisher ID: 4571
                DOI: 10.1007/s00467-020-04571-x
                PMC ID: 7501104
                PubMed ID: 32385527
                SO-VID: a1d31ffc-8ba9-4212-8dd8-8fd1b34bfcd3
                Copyright © © The Author(s) 2020
                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 : 27 January 2020
                Date revision received : 12 March 2020
                Date accepted : 6 April 2020
                Funding
                Funded by: National Institute for Health Research, UK
                Award ID: CDF-2016-09-038
                Award Recipient :
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © IPNA 2020

                ScienceOpen disciplines: Nephrology
                Keywords: calcium,diet,bones,chronic kidney disease,dialysis
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: calcium, diet, bones, chronic kidney disease, dialysis

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