Energy and protein requirements for children with CKD stages 2-5 and on dialysis–clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

AbstractDietary management in pediatric chronic kidney disease (CKD) is an area fraught with uncertainties and wide variations in practice. Even in tertiary pediatric nephrology centers, expert dietetic input is often lacking. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, was established to develop clinical practice recommendations (CPRs) to address these challenges and to serve as a resource for nutritional care. We present CPRs for energy and protein requirements for children with CKD stages 2–5 and those on dialysis (CKD2–5D). We address energy requirements in the context of poor growth, obesity, and different levels of physical activity, together with the additional protein needs to compensate for dialysate losses. We describe how to achieve the dietary prescription for energy and protein using breastmilk, formulas, food, and dietary supplements, which can be incorporated into everyday practice. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgment. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

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Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Pediatric Nephrology ◽

10.1007/s00467-020-04852-5 ◽

2020 ◽

Author(s):

Christina L. Nelms ◽

Vanessa Shaw ◽

Larry A. Greenbaum ◽

Caroline Anderson ◽

An Desloovere ◽

...

Keyword(s):

Clinical Practice ◽

Nutritional Status ◽

Clinical Judgment ◽

Nutritional Assessment ◽

Kidney Diseases ◽

Nutrition Status ◽

Low Grade ◽

Practice Recommendations ◽

American Academy Of Pediatrics ◽

Research Recommendations

AbstractIn children with kidney diseases, an assessment of the child’s growth and nutritional status is important to guide the dietary prescription. No single metric can comprehensively describe the nutrition status; therefore, a series of indices and tools are required for evaluation. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. Herein, we present CPRs for nutritional assessment, including measurement of anthropometric and biochemical parameters and evaluation of dietary intake. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Audit and research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.

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Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Pediatric Nephrology ◽

10.1007/s00467-020-04623-2 ◽

2020 ◽

Vol 36 (1) ◽

pp. 187-204

Author(s):

Lesley Rees ◽

◽

Vanessa Shaw ◽

Leila Qizalbash ◽

Caroline Anderson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Growth Parameters ◽

Tube Feeding ◽

Low Grade ◽

Enteral Tube Feeding ◽

Practice Recommendations ◽

The Individual ◽

Disease Stages

AbstractThe nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device (“enteral tube feeding”). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2–5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

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The dietary management of potassium in children with CKD stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Pediatric Nephrology ◽

10.1007/s00467-021-04923-1 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1331-1346

Author(s):

An Desloovere ◽

José Renken-Terhaerdt ◽

Jetta Tuokkola ◽

Vanessa Shaw ◽

Larry A. Greenbaum ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Judgment ◽

Dietary Assessment ◽

Poor Quality ◽

Low Grade ◽

Dietary Management ◽

Healthy Children ◽

Potassium Intake ◽

Practice Recommendations ◽

Dietary Potassium

AbstractDyskalemias are often seen in children with chronic kidney disease (CKD). While hyperkalemia is common, with an increasing prevalence as glomerular filtration rate declines, hypokalemia may also occur, particularly in children with renal tubular disorders and those on intensive dialysis regimens. Dietary assessment and adjustment of potassium intake is critically important in children with CKD as hyperkalemia can be life-threatening. Manipulation of dietary potassium can be challenging as it may affect the intake of other nutrients and reduce palatability. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) for the dietary management of potassium in children with CKD stages 2–5 and on dialysis (CKD2–5D). We describe the assessment of dietary potassium intake, requirements for potassium in healthy children, and the dietary management of hypo- and hyperkalemia in children with CKD2–5D. Common potassium containing foods are described and approaches to adjusting potassium intake that can be incorporated into everyday practice discussed. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.

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EASE: Clinical Implementation of Automated Tumor Segmentation and Volume Quantification for Adult Low-Grade Glioma

Frontiers in Medicine ◽

10.3389/fmed.2021.738425 ◽

2021 ◽

Vol 8 ◽

Author(s):

Karin A. van Garderen ◽

Sebastian R. van der Voort ◽

Adriaan Versteeg ◽

Marcel Koek ◽

Andrea Gutierrez ◽

...

Keyword(s):

Clinical Practice ◽

Automatic Segmentation ◽

Low Grade Glioma ◽

Tumor Segmentation ◽

Low Grade ◽

Clinical Implementation ◽

Volumetric Assessment ◽

Ensure Patient Safety ◽

Volume Measurements ◽

The Individual

The growth rate of non-enhancing low-grade glioma has prognostic value for both malignant progression and survival, but quantification of growth is difficult due to the irregular shape of the tumor. Volumetric assessment could provide a reliable quantification of tumor growth, but is only feasible if fully automated. Recent advances in automated tumor segmentation have made such a volume quantification possible, and this work describes the clinical implementation of automated volume quantification in an application named EASE: Erasmus Automated SEgmentation. The visual quality control of segmentations by the radiologist is an important step in this process, as errors in the segmentation are still possible. Additionally, to ensure patient safety and quality of care, protocols were established for the usage of volume measurements in clinical diagnosis and for future updates to the algorithm. Upon the introduction of EASE into clinical practice, we evaluated the individual segmentation success rate and impact on diagnosis. In its first 3 months of usage, it was applied to a total of 55 patients, and in 36 of those the radiologist was able to make a volume-based diagnosis using three successful consecutive measurements from EASE. In all cases the volume-based diagnosis was in line with the conventional visual diagnosis. This first cautious introduction of EASE in our clinic is a valuable step in the translation of automatic segmentation methods to clinical practice.

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Assessing liver function and hyperbilirubinemia in the newborn

Clinical Chemistry ◽

10.1093/clinchem/43.1.228 ◽

1997 ◽

Vol 43 (1) ◽

pp. 228-234 ◽

Cited By ~ 31

Author(s):

Philip Rosenthal

Keyword(s):

Enzyme Activity ◽

Clinical Practice ◽

Liver Function ◽

Clinical Judgment ◽

Serum Concentrations ◽

Placental Function ◽

Developmental Sequences ◽

Neonatal Liver ◽

Hepatocyte Damage ◽

The Individual

Abstract In clinical practice, “liver function” is assessed by either measuring the concentration of substances produced by the hepatocyte, measuring the serum content of substances that are changed by hepatocyte damage, evaluating the serum concentrations of substances released from the cells as a result of injury, assessing the ability of the liver to perform a metabolic task such as conjugation or detoxification, or by measuring enzyme activity and substrate content of the cell and its organelles. After birth, with cessation of placental function, the neonatal liver must assume many different tasks. Distinct developmental sequences rapidly progress for numerous hepatic functions as the newborn adapts to its environment. This manuscript is an attempt to provide guidelines for the evaluation and management of the newborn infant when assessing liver function and hyperbilirubinemia. These guidelines, like all sets of guidelines, are only recommendations and do not substitute for good clinical judgment based upon the individual circumstances of each patient.

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The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

Pediatric Nephrology ◽

10.1007/s00467-019-04370-z ◽

2019 ◽

Vol 35 (3) ◽

pp. 501-518 ◽

Cited By ~ 10

Author(s):

Louise McAlister ◽

Pearl Pugh ◽

Laurence Greenbaum ◽

Dieter Haffner ◽

Lesley Rees ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Judgment ◽

High Morbidity ◽

Low Grade ◽

Dietary Management ◽

Healthy Children ◽

Vitamin D Levels ◽

Practice Recommendation ◽

Skeletal Complications ◽

The Common

AbstractIn children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists, who develop clinical practice recommendations (CPRs) for the nutritional management of various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2–5 and on dialysis (CKD2-5D), describing the common Ca- and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo- and hypercalcemia and hyperphosphatemia. The statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.

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