Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy

Growth in children with chronic renal failure caused by polyuric, salt-wast ing diseases may be hampered if ongoing sodium and water losses are not cor rected. Twenty-four children were treated with polyuric chronic renal insuf ficiency (CRI; creatinine clearance <65 ml/min per 1.73 m(2)) with low-calo ric-density, high-volume, sodium-supplemented feedings. Subsequent growth w as compared with that of children in two control groups: a national histori c population control from the US Renal Data System database (n = 42), and a literature control (n = 12). Members of the three groups were 81 to 96% wh ite, and 58 to 70% were boys. Obstructive uropathy and dysplasia were the c ause of CRI in 92% of the treatment group, 75% of the literature control gr oup, and 30% of the population control group. Treatment effect was assessed in a multivariate, retrospective analysis of the height standard deviation score (SDS), simultaneously controlling for the severity of disease by ren al replacement therapy, primary cause of CRI, and initial height SDS. The c hange in SDS (<Delta>SDS) for height by regression analysis at 1 yr was sig nificantly greater by +1.37 in the treatment group versus the population co ntrol (P = 0.017). The 2-yr height Delta SDS by regression analysis adjuste d for creatinine clearance was significantly greater by +1.83 in the treatm ent group versus the literature control (P = 0.003). Nutritional support wi th sodium and water supplementation can maintain or improve the growth of c hildren with polyuric, salt-wasting CRI. This inexpensive intervention may delay the need for renal replacement therapy, growth hormone treatment, or both in many of these children and may be used in any clinical setting.