Nutritional intervention and growth in children with chronic renal failure

Abstract

Objective: To assess whether improving energy intake by tube feeding could prevent growth failure and improve growth rates in children with congenital renal failure.

Design: Prospective descriptive study.

Setting: Renal Units, Royal Alexandra Hospital for Children, and Westmead Hospitals.

Patients: All children with advanced chronic renal disease (glomerular filtration rate < 30 mL/min/1.73 m2) between 1992 and 1994.

Intervention: Tube feeding was commenced if height or weight standard deviation score (SDS) was below the normal range (> -2 SDS) or when height SDS was decreasing and oral intake was not meeting energy requirements. Energy requirements were calculated for median weight for chronological age and sex to provide for catch-up growth.

Main outcome measures: Growth rate was measured by comparing height and weight SDS at the beginning and end of the study period. Normal growth rate is defined as no change in SDS over time, whereas catch-up growth is defined as an increase in SDS over time.

Results: Seven children, mean age 0.6 +/- 0.7 years, with advanced renal failure (mean glomerular filtration rate = 17 mL/min/1.73 m2) caused by congenital renal hypoplasia/dysplasia were studied. All subjects were eventually tube fed for a mean time of 18. 6 +/- 4.5 months. There was no significant change in height SDS (-0. 9 to -1.1) or weight SDS (-0.4 to -0.2).

Conclusion: Optimizing nutritional intake by tube feeding children with advanced chronic renal failure from an early age resulted in no decline in growth rate; however, catch-up growth was not achieved.