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KDOQI Nutritional Guideline for Children with CKD: 2008 Update
Donna Secker PhD RD, The Hospital for Sick Children, Toronto, Canada
NEW YORK, NEW YORK (December 1, 2008) - The KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, released in the year 2000, included 27 adult guidelines and 10 pediatric guidelines. KDOQI Guidelines continue to evolve, and in 2007 an update for a stand-alone pediatric document was deemed warranted.
Rationale for 2008 Update:
- expansion to cover earlier stages of CKD + transplantation, not just ESKD
- inclusion of newer research
- incorporation of most recent population-based recommendations
- inclusion of topics previously not addressed
- reconciliation of inconsistencies with other KDOQI Guidelines
Quality of Evidence:
- limited pediatric studies, small sample sizes, indeterminate results, outcomes rarely examined
- development of clinical practice recommendations, not guidelines
Topics Addressed |
New Additions and Clinical Questions Addressed |
Evaluation of Growth & Nutritional Status |
CDC vs WHO growth charts; BMI; Usefulness of serum albumin, circumferences/skinfolds; multi-parameter indexes; BIA/DEXA; nPCR |
Growth Hormone Therapy |
Indications & contraindications; Use in infants?; Adequacy of caloric intake; When to discontinue? |
Nutrition Management & Counseling |
How often? By whom? |
Energy Requirements & Therapy |
RDA vs DRI; Fats; Fiber; When & how to insert gastrostomy tubes to minimize peritonitis risk?; Safety & effectiveness of IDPN, Eating on HD |
Protein Requirements & Therapy |
Are current recommendations too high? IPAA |
Vitamin/Trace Element Requirements & Therapy |
Tables: Effects of deficiency & excess; Comparison of multivitamin products |
Mineral Requirements & Therapy |
Ca; PO4; Vitamin D |
Fluid & Electrolyte Requirements & Therapy |
Na & fluid supplementation; Na & fluid restriction; K restriction |
Carnitine |
Identify carnitine deficiency and considerations for supplementation |
Transplant Patients |
Nutrient requirements & dietary modifications; Good food safety/hygiene practices |
Public Review
- open to all to review guideline statements and provide feedback
- sign up at: www.kidney.org/professionals/KDOQI
- starting September 2008; 4 weeks
Publication
- American Journal of Kidney Diseases, early 2009
| Co-Chairs | |
| Bradley Warady, MD | Children’s Mercy Hospital Kansas City, MO |
| Donna Secker, PhD RD | Hospital for Sick Children, Toronto, Canada |
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| Working Group Members | Â |
| Bethany Foster, MD | Montreal Children’s Hospital, Montreal, Canada |
| Stuart Goldstein, MDÂ Â | Baylor College of Medicine, Houston, TX |
| Frederick Kaskel, MD, PhD | Children's Hospital at Montefiore, Bronx, NY |
| Sarah Ledermann, MB | Great Ormond Street Hospital for Children, London, UK |
| Franz Schaefer, MD | University Hospital Heidelberg, Germany |
| Nancy Spinozzi, RD, LDN | Children’s Hospital Boston, MA |
The National Kidney Foundation is dedicated to the prevention of kidney and urinary tract disease, improving the health and well-being of patients and families affected by these diseases and increasing the availability of all organs for transplantation.