ESPN 51th Annual Meeting

ESPN 2018


 
Analysis of nutritional blood concentrations in enteral tube feed dependent children with chronic kidney disease.
TRIONA JOYCE 1 FRANCES COURT BROWN 1 PERNILLE RASMUSSEN 1 CAROLINE BOOTH 1 JOANNA CLOTHIER 1

1- EVELINA LONDON CHILDRENS HOSPITAL, GUYS AND ST. THOMAS NHS FOUNDATION TRUST
 
Introduction:

 There is little known about the nutritional blood concentrations and supplementation needs of children with chronic kidney disease (CKD) who are enteral tube feed dependent.  The objective of this survey was to evaluate the proportion of children with CKD achieving normal blood concentrations for copper, zinc, selenium, folate and vitamins A, B12, D and E.

Material and methods:

 Retrospective review of nutritional blood results between January 2016 and 2018

Results:

 11 children, 6 boys, average eGFR 12-42ml/min/1.73 m2, median (IQ1, IQ3) age 5.85 (3.28, 12.70) years.  CKD diagnosis included renal dysplasia (n=5), obstructive uropathy (n=3), renovascular disease (n=2) and tubulo-interstitial disease (n=1).  Two received a vitamin/mineral supplement (Wellkid® or Wellbaby®).  No child received vitamin D supplementation.  Mean blood concentrations of vitamins A (n=10) and B12 (n=11) were all above the normal ranges.  Vitamin E and selenium levels were within or above normal range. Mean vitamin D and folate concentrations were sufficient in all patients. Deficiencies were evident for zinc (n=2/9) and copper (n=1/9).  In the child with copper deficiency, enteral feeds provided 1.08mg daily (RNI 0.8mg).  In those with zinc deficiency, enteral feeds provided 7.6mg (RNI 9mg) and 9mg daily (RNI 7mg).  

Conclusions:

  The majority of the nutritional bloods concentrations were either within or above the normal ranges.  Annual nutritional blood monitoring should focus on zinc and copper in this group of children with 6 to 12 monthly vitamin D monitoring.  Targeted supplementation rather than multinutrient supplementation appears to be indicated in this population group.