Nutrition management in childhood kidney disease: An integrative and lifecourse approach

Infants, children, and adolescents with chronic kidney disease (CKD), end-stage renal disease (ESRD), and kidney disorders such as nephrotic syndrome face unique nutritional challenges. The goals of this chapter are to outline the nutritional problems associated with various forms of kidney disease and describe interventions to correct them. The approach to nutritional management varies greatly based on the age of the child and type of kidney disorder. The primary goals of nutrition in infants and young children with CKD are to promote adequate weight gain, linear growth, and hydration as well as maintain electrolyte homeostasis. For older children and teenagers with CKD and ESRD, the traditional nutritional goals have focused on the management of potassium and phosphorus, fluid balance, and growth. However, as our understanding of nutrition evolved, it is now recognized that diet (quantity and quality of food) has far-reaching effects on overall health. Nutrition is extremely important in modulating inflammation, immune function, and the gut microbiome, all of which play a major role in preventing chronic diseases including cardiovascular disease (CVD) and cancer. A large body of research over the past decade has led to a paradigm shift in nutrition and kidney disease. The recommendations for protein intake in the ESRD population as well as the most effective way to manage dietary phosphorus have changed dramatically. In addition, in some cases of idiopathic nephrotic syndrome, diet therapy has been effective as a treatment of the disease rather than simply managing symptoms. The following sections will identify nutritional problems in various kidney disorders and describe the diet therapy to best help manage them.