Kronik Böbrek Hastalığında Beslenme

Year 2023, Volume: 2 Issue: 4, 219 - 225, 25.12.2023

Derya Özmen , Betül Pehlivan Zorlu , Nida Dinçel

https://doi.org/10.57221/izmirtip.1198911

Abstract

AMAÇ: Kronik böbrek hastalığı (KBH) yapısal veya fonksiyonel böbrek hasarının en az 3 ay boyunca devam etmesi olarak tanımlanır. KBH’da çocuklar büyüme geriliği açısından belirgin risk altındadır. Bu nedenle beslenmenin yakın izlemi önemlidir.

GEREÇ VE YÖNTEMLER: KDIGO ve konu ile ilgili makaleler taranarak KBH' da beslenme önerileri derlenmiştir.

BULGULAR: KDIGO başlıklar altında önerilerde bulunmuştur. Periyodik aralıklarla evre 2-5 KBH’lı tüm çocuklar beslenme durumu ve büyüme çizelgeleri ile takip edilmelidir. Beslenme durumu 3 günlük diyet listesi ya da 3 defa 24 saatlik diyet listesi ile değerlendirilmelidir. Büyüme değerlendirmesinde ağırlık ve boy, yaşa göre percentil çizelgeleri ya da SDS ile takip edilmelidir. Tahmini kuru ağırlık ve yaşa göre ağırlık percentilleri değerlendirilmelidir. Yine vücut kitle indeksi ve 3 yaş altında baş çevresi takibi yapılmalıdır. KBH Evre 5 hemodiyaliz hastalarında normalize edilmiş protein katabolizma hızı hesaplanmalıdır. Takip sıklığı hastanın yaşına ve hastalığın evresine, beslenme ve büyüme duruma göre planlanmalıdır. Fakat genel olarak belirlenen, sağlıklı yaşıtlarına göre 2 kat sıklıkta izlenmeleridir. Poliüri, büyüme gelişme geriliği, gerileyen veya düşük BMI, besin alımında yetersizlik ve sık hastalanan çocuk ve infantlarda izlem sıklığı artırılmalıdır. Kişiselleştirilmiş bir beslenme planı çocuk ve bakım veren için planlanmalıdır. Beslenme yönetiminde asıl olarak önerilen planlamanın pediatrik nefroloji ekibi, diyetisten ve çocuğun bakıcısı ile eş zamanlı olarak multidisipliner şekilde yürütülmesidir.
KBH’da risk faktörleri modifiye edilebilir ve edilemez olarak ayrılabilir. Modifiye edilemeyen risk faktörleri; düşük doğum ağırlığı, prematürite, azalan böbrek kütlesi ile somatik büyüme, daha önceki akut böbrek hasarı, düşük GFR iken; modifiye edilebilir risk faktörleri; hipertansiyon, proteinüri, obezite, asidoz, anemi, vasküler disfonksiyon, sigaradır. Bunun dışında bir de ilerlemeyi artıracak faktörler göz önünde bulundurulmalıdır. Bunlar ise; artmış ürik asit düzeyi, metabolik sendrom, glomerüler hiperfiltrasyon, hiperfosfatemi, artmış plazma FGF23 düzeyidir.

SONUÇ: Çocuklarda kronik böbrek hastalığı (KBH) ilerledikçe iştah ve besin alımı azalır. Bu nedenle iştahsızlık, besinlerin bağırsaklardan emiliminde azalma, fiziksel ve nörobilişsel gelişimi etkileyen metabolik asidoz nedeniyle malnutrisyon sık görülür. Kilo kaybı özelikle GFR <35 mL/dk/1,73m2’ye düştüğünde meydana gelir ve bu da SDBY için yüksek risk teşkil eder. Belirli büyüme parametrelerine bağlı beslenme tedavisi KBH olan çocuklar için geliştirilmiş olup pediatristler ve beslenme uzmanları ile koordine bir şekilde takip edilmelidir.

Keywords

beslenme, kronik böbrek, kalori, calorie

NUTRITION IN CHRONIC KIDNEY DISEASE

Abstract

AİM: Chronic kidney disease (CKD) is defined as the persistence of structural or functional kidney damage for at least 3 months. Children in CKD are at significant risk for growth retardation. Therefore, monitoring of nutrition is important.

MATERİALS AND METHODS: Nutrition recommendations in CKD were compiled by scanning KDIGO and related articles.

RESULTS: KDIGO made recommendations. All children with CKD stages 2-5 should be followed periodically with nutritional status and growth charts. Nutritional status should be evaluated with a 3-day diet list or a 3-time 24-hour diet list. In growth assessment, weight and height should be followed with percentile charts for age or SDS. Estimated dry weight and weight percentiles for age should be evaluated. Body mass index and head circumference under 3 years of age should be monitored. Normalized protein catabolism rate should be calculated in CKD Stage 5 hemodialysis patients. The frequency of follow-up should be planned according to the age of the patient and the stage of the disease, nutrition and growth status. However, what is generally determined is that they are observed twice as often as their healthy agemates. The frequency of follow-up should be increased in children and infants with polyuria, growth retardation, regressing or low BMI, inadequate food intake, and frequently sick children. A personalized nutrition plan should be planned for the child and caregiver. In nutritional management, the recommended planning is to be carried out in a multidisciplinary manner simultaneously with the pediatric nephrology team, dietitian and child's caregiver.

Risk factors in CKD can be divided into modifiable and non-modifiable. Unmodifiable risk factors; low birth weight, prematurity, somatic growth with decreased kidney mass, previous acute kidney injury, low GFR. Modifiable risk factors; hypertension, proteinuria, obesity, acidosis, anemia, vascular dysfunction, smoking. In addition, factors that will increase progress are increased uric acid level, metabolic syndrome, glomerular hyperfiltration, hyperphosphatemia, increased plasma FGF23 level.

CONCLUSION: As CKD progresses in children, appetite and food intake decrease. Therefore, malnutrition is common due to loss of appetite, decreased absorption of nutrients from the intestines, and metabolic acidosis that affects physical and neurocognitive development. Weight loss occurs especially when GFR falls to <35 mL/min/1.73m2, which poses a high risk for ESRD. Nutritional therapy based on specific growth parameters has been developed for children with CKD and should be followed in coordination with pediatricians and nutritionists.

Keywords

nutrition, chronic kidney, calorie

References

• 1.Andrassy KM. Comments on 'KDIGO 2012 Clinical Prac ce Guideline for the Evalua on and Management of Chronic Kidney Disease'. Kidney interna al. 2013;84:622-3.
• 2.Schnaper HW. Pathophysiology of Progressive Renal Disease in Children. In: Avner ED, editor. Pediatric nephrology. Seventh Edi on, 2016.
• 3.Na onal Kidney F. K/DOQI clinical p e guidelines for chronic kidney disease: evalu on, classifica , and s fica on. American journal of kidney diseases : the official journal of the onal Kidney Founda . 2002;39(Suppl 1):S1-266.
• 4.Foster BJ, Leonard MB. Measuring nutri onal status in children with chronic kidney disease. The American journal of clinical nutri on. 2004;80:801-14.
• 5.Kopple JD. onal kidney found on K/DOQI clinical p e guidelines for nutri on in chronic renal failure. American journal of kidney diseases : the official journal of the Na l Kidney Founda . 2001;37(Suppl 2):S66-70.
• 6.Ayestaran FW, Schneider MF, Kaskel FJ, Srivaths PR, Seo-Mayer PW, Moxey-Mims M, et al. Perceived appe te and clinical outcomes in children with chronic kidney disease. Pediatric nephrology. 2016;31:1121-7.
• 7.Chen W, Ducharme-Smith K, Davis L, Hui WF, Warady BA, Furth SL, et al. Dietary sources of energy and nutrient intake among children and adolescents with chronic kidney disease. Pediatric nephrology. 2017;32:1233-41.
• 8.Sgambat K, Matheson MB, Hooper SR, Warady B, Furth S, Moudgil A. Prevalence and outcomes of fragility: a frailty-inflamma on phenotype in children with chronic kidney disease. Pediatric nephrology. 2019;34:2563-9.
• 9.Ku E, Kopple JD, McCulloch CE, Warady BA, Furth SL, Mak RH, et al. Associa ns Between Weight Loss, Kidney Func on Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. American journal of kidney diseases : the official journal of the Na onal Kidney Found on. 2018;71:648-56.
• 10.Group KW. KDOQI Clinical e Guideline for Nu on in Children with CKD: 2008 update. Execu e summary. American journal of kidney diseases : the official journal of the onal Kidney Founda . 2009;53(Suppl 2):S11-104.
• 11.Betts PR, Magrath G, White RH. Role of dietaryenergy supplementa n in growth of children withchronic renal insufficiency. Br Med J. 1977;1:416-8.
• 12.Rees L, Shaw V, Qizalbash L, Anderson C, Desloovere A, Greenbaum L, et al. Delivery of a nutri al prescrip n by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical p e recommenda s from the Pediatric Renal Nu on Taskforce. Pediatric nephrology. 2021;36:187-204.
• 13.Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Randomised mul ntre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutri l Treatment of Chronic Renal Failure in Childhood. Lancet. 1997;349:1117-23.
• 14.Shaw V, Polderman N, Renken-Terhaerdt J, Paglialonga F, Oosterveld M, Tuokkola J, et al. Energy and protein requirements for children with CKD stages 2-5 and on dialysis-clinical p e recommenda from the Pediatric Renal Nutri on Taskforce. Pediatr Nephrol. 2020;35:519-31.
• 15.Uauy RD, Hogg RJ, Brewer ED, Reisch JS, Cunningham C, Holliday MA. Dietary protein and growth in infants with chronic renal insufficiency: a report from the Southwest Pediatric Nephrology Study Group and the University of California, San Francisco. Pediatric nephrology. 1994;8:45-50.
• 16.Chaturvedi S, Jones C. Protein restric on for children with chronic renal failure. The Cochrane database of systema c reviews. 2007:CD006863.
• 17.Uribarri J, Tu e KR. Advanced on end products and nephrotoxicity of high-protein diets. Clinical journal of the American Society of Nephrology : CJASN. 2006;1:1293-9.
• 18.Mahan JD, Warady BA, Consensus C. Assessment and treatment of short stature in pediatric pa nts with chronic kidney disease: a consensus statement. Pediatric nephrology. 2006;21:917-30.
• 19.Rene G. VanDeVoorde CSW, and Bradley A. Warady. Management of Chronic Kidney Disease in Children. In : Avner ED, editor. Pediatric nephrology, 2016.
• 20.Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE. Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatric nephrology. 1991;5:29-32.
• 21.Saland JM, Pierce CB, Mitsnefes MM, Flynn JT, Goebel J, Kupferman JC, et al. Dyslipidemia in children with chronic kidney disease. Kidney interna al. 2010;78:1154-63.
• 22.Baek HS, Kim SH, Kang HG, Choi HJ, Cheong HI, Ha IS, et al. Dyslipidemia in pediatric CKD pa ents: results from KNOW-PedCKD (KoreaN cohort study for Outcomes in pa ents With Pediatric CKD). Pediatric nephrology. 2020;35:1455-61.
• 23.Palmer SC, Strippoli GF, Craig JC. KHA-CARI commentary on the KDIGO Clinical Prac e Guideline for Lipid Management in Chronic Kidney Disease. Nephrology. 2014;19:663-6.