CHAPTER 84: Nutritional Challenges and Growth Failure in Pediatric Patients: Pretransplant and Posttransplant

NUTRITION ASSESSMENT

• Multiple factors affect the growth and nutritional status in patients with chronic kidney disease (CKD)

• Assessment of the nutritional status is imperative to prevent growth failure, minimize consequences of uremia, enhance quality of life, and improve survival pretransplant and posttransplant

• Nutritional management of children with CKD is a challenge that requires continuous reassessment and readjustment as the child ages and CKD progresses

• Evaluation of growth may include:

  • Accurate and frequent measurements

  • For infants, measure length with infant in supine position (Table 84-1)

  • For children older than 2 years of age using standing height measurements (Table 84-2)

  • Use of special growth charts available for patients with Down syndrome, Turner syndrome, or Williams syndrome and for preterm infants

  • Determining growth velocity

  • Evaluate growth potential with bone age and determining mid-parental height

    • Boys: (Father’s height (cm) + Mother’s height (cm) + 13 cm)/2

    • Girls: (Father’s height (cm) + Mother’s height (cm) – 13 cm)/2

PRETRANSPLANT NUTRITIONAL CHALLENGES

• Growth failure is a known complication of CKD (affecting ~33% of CKD patients)

• Children whose onset of kidney failure begins in infancy have the most severe growth failure because a child grows one third of his total height in the first 2 years of life

• In order to proceed with transplant, infants and toddlers are usually required to weigh approximately 9–10 kg (center dependent)

• Lower renal function is associated with higher risk and severity of growth failure

• Growth failure is associated with:

  • Decreased self-esteem/psychosocial development

  • Poor grades/school attendance

  • Poor quality of life

  • Increased morbidity and mortality

  • Factors affecting adequate intake:

    • Picky eating, poor appetite, early satiety, altered sense of taste

    • Gastroesophageal reflux, delayed gastric emptying, nausea/vomiting

    • Metabolic acidosis

    • Uremia

    • Growth hormone (GH) resistance

DIETARY INTAKE AND SPECIAL CONSIDERATIONS

• CKD alters the status of many vitamins and minerals that are essential for growth and development

• Increased risk of deficiencies are due to:

  • Limited or restricted food intake

  • Abnormal gastrointestinal ...