Govindan Sukanya, Iyengar Arpana, Mohanasundaram Subashri, Priyamvada P S
Department of Pediatric Nephrology, Mehta Multispeciality Hospitals India Private Limited, Chennai, Tamil Nadu, India.
Department of Pediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India.
Indian J Nephrol. 2025 Mar-Apr;35(2):187-197. doi: 10.25259/IJN_222_2024. Epub 2024 Nov 28.
Malnutrition, encompassing both undernutrition and overnutrition, is prevalent among patients with chronic kidney disease (CKD). It is influenced by a myriad of factors, including dietary restrictions, metabolic irregularities, inflammation, and comorbidities. It leads to increased morbidity, mortality, and diminished quality of life. In children, malnutrition hinders growth and development, particularly during infancy and early childhood. This article provides a comprehensive overview of current terminologies delineating undernutrition and overnutrition in CKD, and discusses age-specific nutritional assessment tools. It delves into macro- and micronutrient prescriptions tailored for both adults and children with CKD, emphasizing special considerations such as low and very low protein diets. A focus on the nutrient content of Indian foods is also provided, alongside available nutritional supplements, with insights into enteral feeding and the fortification of feeds in young children. Distinctive nuances in nutritional therapy between adults and children are elucidated throughout the article, drawing upon established guidelines, including Kidney Disease Outcomes and Quality Initiative (KDOQI) 2009 and 2020 and KDIGO CKD 2024 guidelines as well as Pediatric Renal Nutrition Task Force clinical practice recommendations, to inform dietary management strategies for individuals across the lifespan living with CKD.
营养不良,包括营养不足和营养过剩,在慢性肾脏病(CKD)患者中普遍存在。它受到众多因素的影响,包括饮食限制、代谢紊乱、炎症和合并症。它会导致发病率和死亡率增加,以及生活质量下降。在儿童中,营养不良会阻碍生长发育,尤其是在婴儿期和幼儿期。本文全面概述了目前用于描述CKD中营养不足和营养过剩的术语,并讨论了针对不同年龄段的营养评估工具。它深入探讨了为成年和儿童CKD患者量身定制的宏量和微量营养素处方,强调了低蛋白和极低蛋白饮食等特殊注意事项。文章还关注了印度食物的营养成分以及现有的营养补充剂,并深入探讨了幼儿的肠内喂养和强化喂养。本文借鉴了包括2009年和2020年《肾脏病预后质量倡议》(KDOQI)以及2024年KDIGO CKD指南以及儿科肾脏营养工作组临床实践建议等既定指南,阐明了成人和儿童营养治疗的独特细微差别,为不同年龄段的CKD患者提供饮食管理策略。