Bone mineral and vitamin D
Calcium and phosphorus, while essential for bone health, can promote soft-tissue calcification and CVD if consumed excessively by children with CKD. The Work Group suggests limiting intake of elemental calcium in CKD stages 2-5 to 100%-200% of the DRI for age and adjusting phosphorus intake to 80%-100% DRI for age in stages 3-5 to achieve and maintain target levels of serum phosphorus and parathyroid hormone (PTH). Checking serum vitamin D (25-hydroxyvitamin D) annually and supplementing levels <30 ng/mL with vitamin D2 (ergocalciferol) or D3 (cholecalciferol) are recommended.
Fluid and electrolytes
The guideline notes that “although restriction of sodium and/or fluids is appropriate in children with CKD associated with sodium and water retention, the most common causes of CKD in children are associated with excessive loss of sodium and chloride.” Accordingly, recommendations for fluid and electrolytes are specific to kidney disease cause, CKD stage, and type of dialysis children are receiving.
Similar to the adult nutrition guidelines, “there is currently insufficient evidence to suggest a role for carnitine therapy in children with CKD stage 5D.”
Included in the guideline are dietary recommendations for the immediate post-transplant period, as well as strategies to minimize possible side effects of immunosuppressive medications (i.e., undesired weight gain, hyperglycemia, osteoporosis, dyslipidemia, increased susceptibility to food-borne illness).
Young patients still in their growing years are at particular risk of nutritional deficiencies associated with CKD. The importance of implementing the recommendations made in the new KDOQI Guideline as early in the disease process as possible cannot be overemphasized.