Catch-up growth in children with chronic kidney disease started on enteral feeding after 2 years of age

• Published in: Pediatric nephrology (Berlin, West) West), 2020-01, Vol.35 (1), p.113-118
• Main Authors: Marlais, Matko, Stojanovic, Jelena, Jones, Helen, Cleghorn, Shelley, Rees, Lesley
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Body height; Body Height - physiology; Body Mass Index; Child; Child Development - physiology; Child, Preschool; Children; Enteral feeding; Enteral nutrition; Enteral Nutrition - methods; Enteral Nutrition - statistics & numerical data; Epidermal growth factor receptors; Female; Follow-Up Studies; Growth hormones; Hemodialysis; Humans; Kidney diseases; Male; Medicine; Medicine & Public Health; Nephrology; Original; Original Article; Ostomy; Pediatrics; Peritoneal dialysis; Peritoneal Dialysis - statistics & numerical data; Peritoneum; Renal Dialysis - statistics & numerical data; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Time-to-Treatment - statistics & numerical data; Transplantation; Transplants & implants; Treatment Outcome; Urology; What’s New in Chronic Kidney Disease
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-019-04382-9

Background Enteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age. Methods Retrospective study of pre-transplant, pre-pubertal children (< 11 years) with CKD stages 2–5 started on nasogastric tube or gastrostomy feeds for the first time after age 2 years. Children were identified by searching dietetic records and the renal database. Children on growth hormone were excluded. Height, weight, and BMI were documented 1 year prior to and at the start of tube feeds, and after 1 and 2 years. Data collection ceased at transplantation. Results Fifty children (25 male) were included. The median (range) age at start of tube feeds was 5.6 (2.1–10.9) years. Sixteen children were dialysed (1 haemodialysis, 15 peritoneal dialysis); 34 predialysis patients had a median (range) eGFR of 22 (6–88) ml/min/1.73 m 2 . Overall height SDS (Ht SDS) improved from − 2.39 to − 2.27 at 1 year and − 2.18 after 2 years ( p = 0.02). BMI SDS improved from − 0.72 to 0.23 after 1 year and was 0.09 after 2 years of enteral feeding ( p < 0.0001). Height SDS improved more in children aged 2–6 years (− 2.13 to − 1.68, p = 0.03) and in children not on dialysis (− 2.33 to − 1.99, p = 0.002). Conclusions Enteral tube feeding commenced after 2 years of age in prepubertal children with CKD improves height and weight SDS, with stability of BMI during the second year. Younger children and those not on dialysis had the greatest benefit.