• Hodson E. Protein intake in children. Nephrology 2005 Dec;10(S5):S207-10.



• Hodson E. Protein intake in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Dec. 9 p. [16 references]

This is the current release of the guideline.

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

Assessment of Therapeutic Effectiveness
Evaluation
Management

Family Practice
Nephrology
Nutrition
Pediatrics

Dietitians
Physicians

To review the available evidence for the benefits and adverse effects of recommended protein intakes in children with chronic kidney disease or end-stage kidney disease

Infants and children with chronic kidney disease or end-stage kidney disease receiving dialysis (peritoneal dialysis or hemodialysis)

1. Consideration of optimal protein intake
2. Correction of nitrogen balance

• Creatinine clearance
• Glomerular filtration rate
• Growth
  • Weight
  • Height/length

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 protein intake. 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

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 the safety of protein-restricted diets in children with chronic kidney disease and end-stage 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

1. Children with chronic kidney disease should have a protein intake equivalent to or above the Food and Agriculture Organisation/World Health Organisation/United Nations University (FAO-WHO-UNU) recommendations for healthy children. (Level II evidence)

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• From nitrogen balance studies in 31 children on automated peritoneal dialysis (APD), it has been estimated that these children required a protein intake of 144% of WHO recommendations and an energy intake of 89% of recommended energy intake (REI) for height age to achieve a nitrogen balance of 50 mg/kg/day. Nitrogen balance should be corrected for dietary protein and energy intake.
• Studies in 15 children on continuous ambulatory peritoneal dialysis (CAPD) found that protein losses of 0.22 to 0.28 g/kg/day occur in infants and children aged below 6 years and were significantly higher than the losses of 0.09 to 0.19 g/kg/day seen in older children.
• Studies in children on CAPD found that protein losses correlated inversely with body weight, body surface area and serum albumin levels. Infants had peritoneal protein losses/m² body surface area (BSA) two-fold higher than children weighing more than 20 kg.
• Recommendations for protein intake in children on haemodialysis are based on nitrogen balance studies in adults.

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 management of protein intake in children with chronic kidney disease or end-stage kidney disease

Not stated

Implementation and Audit

Data on height, weight and head circumference in relation to energy, protein and sodium intake and the number of children who require nutritional supplementation by enteral feeding could be collected and analysed by paediatric renal dietitians and members of the Australian & New Zealand Paediatric Nephrology Association (ANZPNA).

Living with Illness

Effectiveness

• Hodson E. Protein intake in children. Nephrology 2005 Dec;10(S5):S207-10.



• Hodson E. Protein intake in children. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Dec. 9 p. [16 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.

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