Catch-up growth in children with chronic kidney disease started on enteral feeding after 2 years of age

Abstract

Background: Enteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age.

Methods: Retrospective study of pre-transplant, pre-pubertal children (< 11 years) with CKD stages 2-5 started on nasogastric tube or gastrostomy feeds for the first time after age 2 years. Children were identified by searching dietetic records and the renal database. Children on growth hormone were excluded. Height, weight, and BMI were documented 1 year prior to and at the start of tube feeds, and after 1 and 2 years. Data collection ceased at transplantation.

Results: Fifty children (25 male) were included. The median (range) age at start of tube feeds was 5.6 (2.1-10.9) years. Sixteen children were dialysed (1 haemodialysis, 15 peritoneal dialysis); 34 predialysis patients had a median (range) eGFR of 22 (6-88) ml/min/1.73 m². Overall height SDS (Ht SDS) improved from - 2.39 to - 2.27 at 1 year and - 2.18 after 2 years (p = 0.02). BMI SDS improved from - 0.72 to 0.23 after 1 year and was 0.09 after 2 years of enteral feeding (p < 0.0001). Height SDS improved more in children aged 2-6 years (- 2.13 to - 1.68, p = 0.03) and in children not on dialysis (- 2.33 to - 1.99, p = 0.002).

Conclusions: Enteral tube feeding commenced after 2 years of age in prepubertal children with CKD improves height and weight SDS, with stability of BMI during the second year. Younger children and those not on dialysis had the greatest benefit.

Keywords: Chronic kidney disease; Enteral feeding; Gastrostomy; Growth; Paediatrics.

Fig. 1

Height, weight and BMI SDS of 50 children 1 year prior to and at the start of enteral tube feeding, and at 1 and 2 year follow up. *p < 0.05 and **p < 0.01 for difference across three time periods (one-way repeated measures ANOVA, three groups compared were at start of enteral tube feeds, 1-, and 2-year follow-up). BMI body mass index, SDS standard deviation score

Fig. 2

Height, weight and BMI of 50 children at the start of enteral tube feeding and at 1- and 2-year follow-up, subdivided by age of starting tube feeds (29 children aged 2–6 years and 21 children aged 6–11 years). *p < 0.05 and **p < 0.01 for difference across three time periods (one-way repeated measures ANOVA). BMI body mass index, SDS standard deviation score

Fig. 3

Height, weight and BMI of 50 children at the start of enteral tube feeding and at 1- and 2-year follow-up, subdivided into 16 children on dialysis and 34 children pre-dialysis when starting tube feeds. *p < 0.05 and **p < 0.01 for difference across three time periods (one-way repeated measures ANOVA). BMI body mass index, SDS standard deviation score