Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysi
- PDF / 433,959 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 111 Downloads / 217 Views
ORIGINAL ARTICLE
Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis Louise McAlister 1 & Selmy Silva 1 & Vanessa Shaw 2,3 & Rukshana Shroff 1,2 Received: 27 January 2020 / Revised: 12 March 2020 / Accepted: 6 April 2020 # The Author(s) 2020
Abstract Background Adequate calcium (Ca) intake is required for bone mineralization in children. We assessed Ca intake from diet and medications in children with CKD stages 4–5 and on dialysis (CKD4–5D) and age-matched controls, comparing with the UK Reference Nutrient Intake (RNI) and international recommendations. Methods Three-day prospective diet diaries were recorded in 23 children with CKD4–5, 23 with CKD5D, and 27 controls. Doses of phosphate (P) binders and Ca supplements were recorded. Results Median dietary Ca intake in CKD4–5D was 480 (interquartile range (IQR) 300–621) vs 724 (IQR 575–852) mg/day in controls (p = 0.00002), providing 81% vs 108% RNI (p = 0.002). Seventy-six percent of patients received < 100% RNI. In CKD4–5D, 40% dietary Ca was provided from dairy foods vs 56% in controls. Eighty percent of CKD4–5D children were prescribed Ca-based P-binders, 15% Ca supplements, and 9% both medications, increasing median daily Ca intake to 1145 (IQR 665–1649) mg/day; 177% RNI. Considering the total daily Ca intake from diet and medications, 15% received < 100% RNI, 44% 100–200% RNI, and 41% > 200% RNI. Three children (6%) exceeded the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) upper limit of 2500 mg/day. None with a total Ca intake < RNI was hypocalcemic, and only one having > 2 × RNI was hypercalcemic. Conclusions Seventy-six percent of children with CKD4–5D had a dietary Ca intake < 100% RNI. Restriction of dairy foods as part of a P-controlled diet limits Ca intake. Additional Ca from medications is required to meet the KDOQI guideline of 100– 200% normal recommended Ca intake.
Keywords Calcium . Diet . Bones . Chronic kidney disease . Dialysis
Introduction Ensuring adequate calcium (Ca) intake, along with maintaining vitamin D status and limiting dietary phosphate (P) exposure, is central to the dietary management of chronic kidney Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04571-x) contains supplementary material, which is available to authorized users. * Rukshana Shroff [email protected] 1
Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
2
University College London Institute of Child Health, London, UK
3
University of Plymouth, Plymouth, UK
disease mineral and bone disorder (CKD-MBD) in children [1]. A low Ca intake is especially of concern in children with chronic kidney disease (CKD) who require Ca for bone accrual and growth and to prevent fractures [2], 90% of peak bone mass being accrued by 18 years of age [3]. Conversely, excess Ca may lead to coronary artery calcification which increases cardiovascular risk, the leading cause of death
Data Loading...
