‘No gold standard’ in monitoring nutrition in children vs. adults with CKD
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Key takeaways:
- Growth is a key nutritional status measure for children, while body composition analysis is more useful in adults.
- Diet interventions may have different impacts on pediatric patients vs. adults.
Monitoring nutritional status is not the same for pediatric and adult patients with chronic kidney disease, and all nephrologists should be aware of the differences, according to an article in Seminars in Nephrology.
“Adult nephrologists caring for children and adolescents may be challenged by the existing complexities in identifying and interpreting nutritional status and growth in children,” Robert H. Mak, MD, PhD, and colleagues wrote. “Pediatric nephrologists may face situations that call for a sound knowledge of assessment in nutritional status and providing nutrition therapy for adolescents and young adults.”
There is “no gold-standard test for nutritional assessment” in children or adults with CKD, the authors noted. Weight, height and rate of growth are key recommended tools in infants through adolescents. For adults, the recommendations shift toward body composition analysis, such as bioimpedance analysis and dual X-ray absorptiometry, and include composite tools, such as subjective global assessment and malnutrition inflammation score.
As for interventions, many adults with CKD also have diabetes, leading to a low-carbohydrate diet, while children with CKD are often prescribed calorie supplements with “quite a lot of carbohydrates” because many are anorexic, the authors noted.
Adults with CKD also often have hypertension and atherosclerotic comorbidities, which call for low-salt and low-fat diets. Children with CKD often require normal- or high-salt diets due to salt- and electrolyte-wasting disease states, and fats are common in calorie supplements.
Low-protein diets, often recommended to slow progression of pre-dialysis CKD in adults, have not been found to slow progression, or achieve normal growth, in children with CKD. Unlike adults, children are also growing and have a higher daily protein requirement, the authors wrote.
Mak and colleagues concluded that nephrologists need to be attuned to the “different nature of kidney diseases” in pediatric vs. adult patients.
“The dynamic phase of growth, metabolic demands in childhood, distinct etiologies of kidney diseases in children and adults, and associated comorbidities make nutritional care dissimilar between adults and children with CKD,” they wrote.
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