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Main points

Main points. Dietary protein intake Lipids/fats Carbohydrates Vitamins and minerals Fluid Energy intake. Dependence on…. Age Stage of CRD (based on GFR ) Treatment (conservative, HD, PD). Restricted (0,75-1,0g/kg/day) (combined with ketoacids).

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Main points

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  1. Main points • Dietary protein intake • Lipids/fats • Carbohydrates • Vitamins and minerals • Fluid • Energy intake

  2. Dependence on… • Age • Stage of CRD (based on GFR ) • Treatment (conservative, HD, PD)

  3. Restricted (0,75-1,0g/kg/day) (combined with ketoacids) Equivalent to or above WHO recommendations for healthy children Dietary protein intake 2 studies (250 children)- 124-Protein reduced diet 126- ~RDA Reducing protein intake does not appear to have a significant impact in delaying the progression to ESKD in children Cochrane Database Syst Rev. 2007 Oct 17(4): CD006863

  4. Adults Blood cholesterol level <4,5 mmol/l Diet manipulation Statins Children - Age dependence Lipids/fats

  5. Carbohydrates/ Energy intake • Carbohydrates should be used to maintain the required daily energy intake • Energy intake- 100% of estimated average requirement (if vomiting - +30% of EAR)

  6. Vitamins • Vitamins - reasonable to give as for normal children • Vit A -hypercalcaemia, anaemia and hyperlipidaemia • Vit D – if PTH (better active forms) • Folic acid – good in GFR <40 ml/min/1,73 m2, but no dosage recommendations

  7. Minerals • Dietary phosphate may need to be restricted when the GFR falls below the normal range, and almost always when below 50 ml/min/1.73 m2. • Phosphate binders • Iron, copper and zinc – anemia (i/v iron), EPO • Potassium, sodium

  8. Fluid / water • Adjust according clinical data (reduced GFR, oedema, hypertension)

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