Energy and protein requirements for children with CKD stages 2–5 and on dialysis — clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

1. Які енергетичні потреби у дітей із хронічним захворюванням нирок стадій 2–5D? 1.1. Ми пропонуємо забезпечувати початкові призначення щодо енергетичного споживання у дітей із хронічним захворюванням нирок (ХЗН) стадій 2–5D приблизно так, як у здорових дітей відповідного віку. (Рівень В; помірна рекомендація). 1.2. Для сприяння оптимальному росту у тих, хто має недостатні приріст ваги та лінійний ріст, ми пропонуємо скорегувати споживання енергії до вищого рівня діапазону рекомендованого харчового споживання їжі (РХС). (Рівень D; слабка рекомендація). 1.3. У дітей з надмірною вагою або ожирінням відрегулюйте споживання енергії, щоб досягти належного збільшення ваги без шкоди для харчування. (Рівень X; сильна рекомендація).

1.1. We suggest that the initial prescription for energy intake in children with CKD 2-5D should approximate that of healthy children of the same chronological age. (Level B; moderate recommendation).
1.2. To promote optimal growth in those with suboptimal weight gain and linear growth, we suggest that energy intake should be adjusted towards the higher end of the suggested dietary intake (SDI). (Level D; weak recommendation).
1.3. In overweight or obese children, adjust energy intake to achieve appropriate weight gain, without compromising nutrition. (Level X; strong recommendation).

What are the protein requirements for children with CKD stages 2-5D?
2.1. We suggest that the target protein intake in children with CKD 2-5D is at the upper end of the SDI to promote optimal growth. (Level C; moderate recommendation). The protein intake at the lowest end of the range is considered the minimum safe amount and protein intake should not be reduced below this level.
dialysis patients to account for dialysate protein losses. (Level C; weak recommendation).
2.3. In children with persistently high blood urea levels, we suggest that protein intake may be adjusted towards the lower end of the SDI, after excluding other causes of high blood urea levels. (Level C; moderate recommendation).

How is the nutritional prescription for energy and protein provided for children with CKD stages 2-5D?
3.1. Breastfeeding is the preferred method for feeding an infant with CKD. (Level X; strong recommendation).
3.2. When breastfeeding is not possible or expressed breastmilk is not available in adequate amounts for the infant with CKD, we suggest that whey-dominant infant formulas be used. (Level A; strong recommendation).
3.3. We suggest that breastmilk and infant formulas should be fortified when there is a prescribed fluid restriction or when a more energy or nutrient dense feed is required to meet nutritional requirements. (Level A; strong recommendation).
3.5. Solid foods should be introduced as recommended for healthy infants, with progression to varied textures and content according to the infant's cues and oral motor skills. We suggest that all children eat a healthy, balanced diet with a wide variety of food choi ces, as for the general population, taking into account possible dietary limitations. (Level D; weak recommendation).
3.6. Oral feeding is the preferred route whenever possible. Oral stimulation is desirable, even if oral intake is limited, to prevent the development of food aversion. (Level C; weak recommendation).
3.7. We suggest prompt intervention once deterioration in weight centile is noted. Oral nutritional supplementation should be started in children with inadequate dietary intake, after consideration of medical management of correctable causes of reduced intake. (Level B, moderate recommendation).
3.8. We suggest that supplemental or exclusive enteral tube feeding should be commenced in children who are unable to meet their nutritional requirements orally, in order to improve nutritional status. (Level B, moderate recommendation).