Feeding patterns and outcomes of enterally tube fed paediatric kidney transplant recipients
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ORIGINAL ARTICLE
Feeding patterns and outcomes of enterally tube fed paediatric kidney transplant recipients Sarah Khweir 1,2
&
Louise McAlister 1 & Stephen D Marks 3,4
Received: 5 March 2020 / Revised: 19 April 2020 / Accepted: 14 May 2020 # IPNA 2020
Abstract Objective Many children with chronic kidney disease (CKD) exhibiting symptoms of poor appetite, gastro-oesophageal reflux and vomiting are reliant on enteral tube feeds (ETF) to achieve adequate nutritional intake. Following a successful renal transplant (RT), some of these symptoms may resolve and ETF then discontinued. There are only a few studies reporting the time taken to transition from ETF to complete oral feeding after transplantation. This study aimed to investigate the time taken to discontinue ETF following RT in children attending a large tertiary nephrology unit. Methods A retrospective review of medical and dietetic records between 1 January 2014 and 31 December 2017. Results The study included 20 paediatric renal transplant recipients (70% male) aged 1 to 17 years. Seventy percent discontinued ETF at a median of 6 (0–70) weeks post-transplantation. Patients had ETF from a median of 0.45 (0–10.8) years of age, for a median of 3.9 (1.1–10.9) years prior to receiving a transplant. Four (20%) were referred to the Feeding and Eating Disorder team at a median of 20 (2–44) months post-renal transplantation. Mean body mass index (BMI) Z-score of 0.43 at 12 months pretransplant was found to be significantly associated with shorter duration of ETF post-transplant (r = 0.8, p = 0.001). Conclusions Forty-five percent of children stopped ETF by a median of 6 weeks post-renal transplant. A good nutritional status pre-transplant may reduce the duration of ETF following transplantation. Four children experienced behavioural feeding issues post-transplant and required further specialist support. Future multi-centre research is required to support these findings to provide a more robust indication of time to achieve full oral feeding. Keywords Enteral tube feeding . Paediatric . Renal transplantation . Outcomes
Introduction Chronic kidney disease (CKD) is an irreversible decline in kidney function, which may progress to end-stage kidney disease Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04618-z) contains supplementary material, which is available to authorized users. * Sarah Khweir [email protected] 1
Dietetics Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
2
School of Health Professions (Faculty of Health and Human Sciences), University of Plymouth, Plymouth, UK
3
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
4
University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
(ESKD) during childhood [1]. The incidence of CKD in children under 16 years of age is approximately nine per million age-
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