• Caring for Australasians with Renal Impairment. Micronutrient intake in children. Nephrology 2005;10(Suppl 5):S213-14.



• Hodson E. Micronutrient intake in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Dec. 4 p. [5 references]

This is the current release of the guideline.

• Chronic kidney disease (CKD)
• End-stage kidney disease (ESKD)

Assessment of Therapeutic Effectiveness
Management

Family Practice
Nephrology
Nutrition
Pediatrics

Dietitians
Physicians

To review the available evidence for the benefits and adverse effects of supplementation of vitamins and micronutrients in children with chronic kidney disease and end-stage kidney disease

Children with chronic kidney disease or end-stage kidney disease on dialysis

1. Supplementation of water soluble vitamins and micronutrients
2. Supplementation of fat soluble vitamins (considered but not recommended)

• Rate of children meeting criteria for recommended daily intake of vitamins and micronutrients
• Dietary intake of micronutrients
• Serum levels of micronutrients

Searches of Electronic Databases

Databases searched: Medline (1996 to November Week 2 2003) and Embase (1980 to November 2003). Medical Subject Heading (MeSH) terms for kidney disease were combined with MeSH terms and text words for micronutrients. The Cochrane Renal Group Specialised Register of randomised controlled trials was also searched for relevant trials not indexed in Medline.

Date of searches: 1 December 2003.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding micronutrient intake in children with chronic kidney disease or end-stage renal disease on dialysis from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Renal Association, Canadian Society of Nephrology, and European Best Practice Guidelines.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV evidence)

• Supplements of water soluble vitamins are indicated in dialysis patients who are not receiving nutritional supplements.
• Supplements of vitamins A, B₁₂, and E are not indicated, since the dietary intake of these vitamins meets recommended daily intakes (RDIs) in children on dialysis.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate micronutrient intake in children with chronic kidney disease and end-stage kidney disease on dialysis

Not stated

Implementation and Audit

The number of children on dialysis who receive a vitamin supplement with or without nutritional supplements and the supplement used could be assessed through the paediatric renal dietitians and the Australian & New Zealand Paediatric Nephrology Association (ANZPNA).

Living with Illness

Effectiveness

• Caring for Australasians with Renal Impairment. Micronutrient intake in children. Nephrology 2005;10(Suppl 5):S213-14.



• Hodson E. Micronutrient intake in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Dec. 4 p. [5 references]

Not applicable: The guideline was not adapted from another source.

2005 Dec

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Author: Elisabeth Hodson

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on March 31, 2008. The information was verified by the guideline developer on June 11, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.