• Hodson E. Evaluation and management of nutrition in children. Nephrology 2005 Dec;10(S5):S215-7.



• Hodson E. Evaluation and management of nutrition in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jan. 6 p. [18 references]

This is the current release of the guideline.

• Chronic kidney disease
• End-stage kidney disease

Counseling
Evaluation
Management

Family Practice
Nephrology
Nutrition
Pediatrics

Dietitians
Physicians

To review the available evidence for appropriate nutritional markers and for the value of nutritional assessment and counselling in children with chronic kidney disease or end-stage kidney disease

Children with chronic kidney disease or end-stage kidney disease

Assessment/Evaluation*

1. Measurement of supine length or standing height, weight
   • Comparison to normal values for chronological age
2. Nutritional assessment and counseling
3. Measurement of serum albumin
4. Calculations of protein equivalent of nitrogen appearance

*Considered but not recommended

• Height (supine length, standing height)
• Weight
• Head circumference
• Skinfold thickness
• Body mass index
• Serum albumin
• Protein equivalent of nitrogen appearance
• Growth rate

Searches of Electronic Databases

Databases searched: Medline (1996 to November Week 2 2003) and Embase (1980 to November 2003). MeSH terms for kidney disease were combined with MeSH terms and text words for nutrition assessment and management. The Cochrane Renal Group Specialized Register of randomized 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

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 evaluation and management of nutrition in children with kidney disease 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 sources)

• Measurements should be made at 1–3 month intervals of supine length or standing height and weight with comparison to normal values for chronological age using percentile charts, standard deviation scores (SDS) and body mass index (BMI).
• Nutrition assessment and counseling should take place at 1–3 month intervals.
• Serum albumin should be measured at 1–3 month intervals.
• Calculations of protein equivalent of nitrogen appearance (nPNA) are not reliable measures of dietary protein intake in children and should not replace nutritional assessment.

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 nutritional assessment and counseling in children with chronic kidney disease or end-stage kidney disease

Not stated

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Hodson E. Evaluation and management of nutrition in children. Nephrology 2005 Dec;10(S5):S215-7.



• Hodson E. Evaluation and management of nutrition in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jan. 6 p. [18 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 April 30, 2008.

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