Pediatric Renal Nutrition Flashcards

In infants with CKD or ESRD, ensuring adequate caloric intake is critical for growth. What is the MOST common reason infants with CKD fail to thrive despite adequate prescribed calorie intake?

Answer: Uremic anorexia, vomiting, and oral aversion leading to inadequate actual oral intake — requiring tube feeding supplementation

Uremic anorexia, recurrent vomiting, and oral aversion (from chronic illness/NG tube experience) frequently prevent infants with CKD from voluntarily consuming adequate calories. Gastrostomy tube (G-tube) feeding is often necessary to achieve prescribed energy targets for growth.

Which parameter is the BEST clinical indicator of adequate nutritional support for linear growth in a child with CKD?

Answer: Height velocity (change in height over time) plotted on standard growth charts compared to age/sex norms

Height velocity (cm/year) plotted on growth charts is the primary indicator of adequate linear growth and nutritional support in pediatric CKD. Adequate growth requires sufficient energy, protein, calcium, phosphorus, vitamin D, and growth hormone signaling.

For a 3-year-old child with CKD Stage 5 on peritoneal dialysis, caloric requirements per kg body weight are HIGHER or LOWER compared to an adult on PD?

Answer: Higher — children require more calories per kg (80–120 kcal/kg/day) than adults to support growth and development

Young children have significantly higher energy needs per kg body weight than adults due to the demands of rapid growth, high metabolic rate, and organ development. A 3-year-old requires approximately 80–120 kcal/kg/day, compared to 30–35 kcal/kg/day for adults.

In a child with CKD Stage 3–4, which vitamin/mineral is MOST critical to monitor and supplement to prevent renal osteodystrophy and support bone growth?

Answer: Active vitamin D (calcitriol or alfacalcidol) combined with calcium supplementation to normalize PTH and support bone mineralization during growth

In CKD Stage 3–4, impaired 1α-hydroxylase activity reduces calcitriol (active vitamin D) production, contributing to hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism, and CKD-MBD — all of which severely impair linear bone growth in children. Active vitamin D supplementation and calcium management are critical.

The MOST important reason to use nasogastric or gastrostomy tube feeding in a pediatric patient with ESRD rather than relying solely on oral feeding is:

Answer: Tube feeding ensures predictable, adequate intake to meet the high caloric and nutritional requirements for normal growth and neurodevelopment when oral intake is chronically insufficient due to uremic anorexia and vomiting

The primary indication for tube feeding in pediatric ESRD is ensuring sufficient caloric intake for growth and neurodevelopment when uremic anorexia, vomiting, and oral aversion prevent adequate voluntary intake. Critical growth windows (especially 0–2 years and puberty) cannot be missed.

A 10-year-old child on hemodialysis has consistent pre-dialysis potassium of 6.8 mEq/L. After reviewing their 3-day food record, which high-potassium food item is MOST commonly over-consumed in the pediatric dialysis population?

Answer: Fruit juices, sports drinks, and carbonated beverages (especially those with added potassium)

Children and adolescents on dialysis frequently consume fruit juices, sports drinks (e.g., Gatorade contains high potassium), and flavored sodas — all high in potassium — and often report these as 'beverages' rather than 'food,' making them easy to overlook in dietary assessment.