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      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

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          Abstract

          In children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. 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 various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2–5 and on dialysis (CKD2-5D), describing the common Ca- and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo- and hypercalcemia and hyperphosphatemia. The statements have been graded, and 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. These CPRs will be regularly audited and updated by the PRNT.

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          The online version of this article (10.1007/s00467-019-04370-z) contains supplementary material, which is available to authorized users.

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          Vitamin D Deficiency

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            GRADE guidelines: 2. Framing the question and deciding on important outcomes.

            GRADE requires a clear specification of the relevant setting, population, intervention, and comparator. It also requires specification of all important outcomes--whether evidence from research studies is, or is not, available. For a particular management question, the population, intervention, and outcome should be sufficiently similar across studies that a similar magnitude of effect is plausible. Guideline developers should specify the relative importance of the outcomes before gathering the evidence and again when evidence summaries are complete. In considering the importance of a surrogate outcome, authors should rate the importance of the patient-important outcome for which the surrogate is a substitute and subsequently rate down the quality of evidence for indirectness of outcome. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass.

              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.
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                Author and article information

                Contributors
                Rukshana.Shroff@gosh.nhs.uk
                Journal
                Pediatr Nephrol
                Pediatr. Nephrol
                Pediatric Nephrology (Berlin, Germany)
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0931-041X
                1432-198X
                30 October 2019
                30 October 2019
                2020
                : 35
                : 3
                : 501-518
                Affiliations
                [1 ]GRID grid.83440.3b, ISNI 0000000121901201, Great Ormond Street Hospital for Children NHS Foundation Trust, and University College London, , Institute of Child Health, ; WC1N 3JH, London, UK
                [2 ]GRID grid.240404.6, ISNI 0000 0001 0440 1889, Nottingham Children’s Hospital, , Nottingham University Hospitals NHS Trust, ; Nottingham, UK
                [3 ]GRID grid.428158.2, ISNI 0000 0004 0371 6071, Emory University and Children’s Healthcare of Atlanta, ; Atlanta, USA
                [4 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Children’s Hospital, , Hannover Medical School, ; Hannover, Germany
                [5 ]GRID grid.430506.4, Southampton Children’s Hospital, , University Hospital Southampton NHS Foundation Trust, ; Southampton, UK
                [6 ]GRID grid.410566.0, ISNI 0000 0004 0626 3303, University Hospital Ghent, ; Ghent, Belgium
                [7 ]GRID grid.24434.35, ISNI 0000 0004 1937 0060, PedsFeeds LLC, , University of Nebraska, ; Nebraska, USA
                [8 ]GRID grid.414503.7, ISNI 0000 0004 0529 2508, Emma Children’s Hospital, , Amsterdam University Medical Center, ; Amsterdam, The Netherlands
                [9 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, ; Milan, Italy
                [10 ]GRID grid.414137.4, ISNI 0000 0001 0684 7788, British Columbia Children’s Hospital, ; Vancover, Canada
                [11 ]Great Northern Children’s Hospital, Newcastle upon Tyne, UK
                [12 ]GRID grid.7692.a, ISNI 0000000090126352, Wilhelmina Children’s Hospital, , University Medical Center Utrecht, ; Utrecht, The Netherlands
                [13 ]GRID grid.7737.4, ISNI 0000 0004 0410 2071, Children’s Hospital and Clinical Nutrition Unit, , University of Helsinki and Helsinki University Hospital, ; Helsinki, Finland
                [14 ]GRID grid.239559.1, ISNI 0000 0004 0415 5050, Children’s Mercy Kansas City, ; Kansas City, USA
                [15 ]GRID grid.83440.3b, ISNI 0000000121901201, University of Plymouth and University College London Institute of Child Health, ; London, UK
                Author information
                http://orcid.org/0000-0001-8501-1072
                Article
                4370
                10.1007/s00467-019-04370-z
                6969014
                31667620
                c8dd1f3e-6419-47e1-a1be-1d3aa5d4f15e
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 1 August 2019
                : 1 September 2019
                : 17 September 2019
                Funding
                Funded by: University College London (UCL)
                Categories
                Guidelines
                Custom metadata
                © IPNA 2020

                Nephrology
                calcium,phosphate,nutrition,chronic kidney disease (ckd),children
                Nephrology
                calcium, phosphate, nutrition, chronic kidney disease (ckd), children

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