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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 88

Nutritional management in children on renal replacement therapy


1 Pediatric Nephrologist, Dr. Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
2 HOD, Consultant Dietician, Department of Dietetics, Global Hospitals, Mumbai, Maharashtra, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_5_19

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How to cite this article:
Mehta K, Patel Z. Nutritional management in children on renal replacement therapy. J Renal Nutr Metab 2018;4:88

How to cite this URL:
Mehta K, Patel Z. Nutritional management in children on renal replacement therapy. J Renal Nutr Metab [serial online] 2018 [cited 2019 Jul 15];4:88. Available from: http://www.jrnm.in/text.asp?2018/4/3/88/256823



As the kidney function declines, there is worsening of glomerular filtration rate (GFR). Once GFR decreases to <15 ml/min, there will be a need for renal replacement therapy.

Renal replacement therapy could be either initiating dialysis or doing kidney transplantation. Dialysis could be either hemodialysis or chronic ambulatory peritoneal dialysis.

As GFR worsens in the chronic kidney disease Stage 3–4, there may be hyperphosphatemia, hyperkalemia, and uremia, which requires dietary modification in the form of dietary restriction of phosphates, potassium, and protein. Salt and fluid restriction is dependent on the volume of urine output, salt wasting, and the presence of hypertension.

In children who are on chronic ambulatory peritoneal dialysis (CAPD), potassium and phosphorus restriction is not necessary they are removed in continuous daily exchanges done during peritoneal dialysis. Protein intake needs to be increased due to loss of proteins during dialysis, and obesity may be a concern due to increased glucose absorption through peritoneal membrane. Daytime fill volume may give rise to feeling of heaviness and decrease the appetite affecting the child's nutrition.

In children on hemodialysis, increased protein requirement is necessary due to loss of proteins, and supplement of B complex vitamins is necessary. During the sessions of dialysis, dietary potassium intake could be increased, and those who are on regular hemodialysis may not need phosphorus restriction. Due to blood loss, requirement of iron and erythropoietin becomes necessary.

In children who receive kidney transplantation, one can increase dietary potassium, phosphates, and proteins. Fresh, boiled, and cooked food should be consumed, and excess salt should be avoided. Increase in fluid consumption is necessary posttransplant. Dietary modification is necessary to increase healthy diet with more fiber intake with less calories to prevent obesity. Hyperlipidemia, obesity, and cardiovascular disease should be prevented by proper dietary counseling and increase in physical activity.






 

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