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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

TABLE 84-1World Health Organization Growth Charts for 2nd and 98th Percentiles (Age 0–24 Months)
TABLE 84-2Centers for Disease Control and Prevention Growth Charts for 5th and 95th Percentile (Age 2–20 Years)

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 ...

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