Pediatric renal dietitians, nephrologists consent on fiber intake for youth with CKD
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Key takeaways:
- Eating high-fiber foods, especially plant-based options, may have a beneficial dietary impact for pediatric patients with CKD.
- Natural fiber or supplements are also options.
Eating a variety of natural fiber-rich foods and avoiding fiber with phosphate additives may help youth with chronic kidney disease to meet adequate dietary fiber intake.
“Dietary fiber has several health benefits and is considered an essential constituent of a healthy diet in adults and children,” An Desloovere, of Ghent University Hospital in Belgium, wrote with colleagues. “Despite the established beneficial effects of dietary fiber, a substantial proportion of children fail to meet the recommended intake of dietary fiber due to a low consumption of whole grains, fruits, vegetables, legumes and nuts. This is especially true for children with chronic diseases such as chronic kidney disease (CKD).”
While the benefits of dietary fiber are well-established, Desloovere and colleagues added that current nutritional guidelines for patients with CKD offer little practical clinical guidance on implementation.
Investigators from the Pediatric Renal Nutrition Taskforce conducted research into the dietary fiber intake of children and adolescents with CKD to develop practical management recommendations for youth to maintain or increase dietary fiber. In an evidence review, the team performed a Delphi survey of pediatric nephrologists and renal dietitians from 14 countries. They reviewed 16 key clinical practice guidelines and an average 90% consensus was achieved with a “strongly agree” or “agree” response.
From that evaluation, the taskforce recommended the following steps:
- Prioritize energy and protein over fiber. The guidelines suggested taking this dietary approach, particularly in youth with poor appetite or those needing higher energy intake.
- Choose intrinsic fiber. Patients should consider natural fiber or supplements.
- Eat a variety of fiber-rich foods. Going for high-fiber products, especially plant-based options, may have a beneficial dietary impact, according to the researchers.
- Address hyperkalemia. If hyperkalemia persists, the consensus suggested limiting foods rich in potassium additives, cutting down on potassium-rich foods with low fiber content and low nutritional value, and consider low potassium fiber-rich foods or fiber supplements.
- Avoid fiber with phosphate additives. Do not restrict fiber-rich foods containing natural phosphate and lower bioavailability but avoid phosphate additives.
- Optimize fiber intake for children with fluid restrictions while taking tolerance and fluid allowance into account.
- Choose nutritional supplements with fiber for children receiving enteral or oral nutritional supplements. Whenever possible, consider adding fiber to low fiber formulas.
“Achieving the recommended intake of fiber in children is important but given the high risk of growth failure in children with CKD, energy and protein intake should be prioritized,” the researchers wrote. “Where possible, we strongly suggest using intrinsic fiber sources rather than added fiber.”
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