Pediatric Nutrition and Growth in Chronic Kidney Disease

Chronic kidney disease in childhood presents a complex interplay of nutritional, hormonal and metabolic challenges that profoundly affect linear growth and overall development. Diminished appetite, protein–energy wasting and micronutrient imbalances arise from uraemic toxins, metabolic acidosis and inflammation, while dialysis pathways may exacerbate nutrient losses. Dysregulation of the growth hormone–insulin-like growth factor axis, anaemia, bone mineral disorders and fluid-electrolyte disturbances further compound growth impairment. Early recognition of nutritional risk, individualised dietary prescriptions and timely interventions such as enteral feeding, correction of metabolic derangements and recombinant growth hormone therapy are central to optimising height attainment and neurocognitive outcomes. Multidisciplinary collaboration among nephrology, dietetics and endocrinology teams underpins improved quality of life and long-term prognosis, with global programmes evolving to address regional disparities in care and resource allocation.

Research from Nature Portfolio

Clinical guidelines on recombinant human growth hormone in paediatric kidney disease have delineated precise criteria for initiation and dosing in children with persistent growth failure, emphasising early assessment once height velocity falls below expected percentiles. These recommendations integrate cost–benefit considerations and advise ongoing monitoring of treatment response, renal graft status and potential side effects. A worldwide registry of children on chronic peritoneal dialysis has revealed substantial variation in nutritional status, with underweight predominating in regions of late dialysis initiation and overweight more common where enteral feeding is routine. Longitudinal data indicate that nutritional status tends to normalise over time on dialysis, but underweight in older children and obesity in infancy are each linked to increased mortality risk.

Pediatric Nutrition and Growth in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in pediatric nutrition and growth in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): Progressive loss of renal function over months or years, classified into stages by glomerular filtration rate.

Glomerular filtration rate (GFR): A measure of kidney function indicating the volume of plasma filtered per minute, used to stage CKD.

Protein–energy wasting: A state of decreased body protein and energy reserves commonly seen in advanced CKD, leading to muscle loss and poor growth.

Enteral feeding: Delivery of nutrition directly into the gastrointestinal tract via tube, used when oral intake is insufficient.

Recombinant human growth hormone (GH): A synthetic form of pituitary hormone administered to promote linear growth in children with growth failure.

References

1. Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease. Nature Reviews Nephrology (2019).
2. Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network. Scientific Reports (2019).
3. The dietary management of potassium in children with CKD stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatric Nephrology (2021).
4. Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatric Nephrology (2020).
5. Energy and protein requirements for children with CKD stages 2-5 and on dialysis–clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatric Nephrology (2019).