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


Identify carnitine deficiency and considerations for supplementation

Transplant Patients

Nutrient requirements & dietary modifications; Good food safety/hygiene practices

Public Review


  • American Journal of Kidney Diseases, early 2009

Bradley Warady, MDChildren’s Mercy Hospital Kansas City, MO
Donna Secker, PhD RDHospital for Sick Children, Toronto, Canada


Working Group Members 
Bethany Foster, MD Montreal Children’s Hospital, Montreal, Canada
Stuart Goldstein, MD  Baylor College of Medicine, Houston, TX
Frederick Kaskel, MD, PhDChildren's Hospital at Montefiore, Bronx, NY
Sarah Ledermann, MBGreat Ormond Street Hospital for Children, London, UK
Franz Schaefer, MDUniversity Hospital
Heidelberg, Germany
Nancy Spinozzi, RD, LDNChildren’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.