Use of Renastart™ in a Child with CKD Stage 3 | Case Study
DESCRIPTION
A case study highlighting the use of Renastart™ in a child with Chronic Kidney Disease (CKD) stage 3.
The patient was a female aged 8 years and 10 months and had been diagnosed with CKD stage 3 due to bilateral dysplasia of the kidneys.
Note:
This information is intended for use by Healthcare Professionals only.
Renastart is a Food for Special Medical Purposes. Must be used under strict medical supervision with regular monitoring of nutritional status and electrolyte levels. For enteral use only. Not suitable as a sole source of nutrition.
Psychomotor retardation, failure to thrive, obesity, wheelchair bound, premature and dysmature, constipation, gastrostomy fed, no fluid restriction.
| Medication | Reason for Use |
| Calcium carbonate (CaCO3) | Phosphate binder |
| Sodium bicarbonate (NaHCO3) | Bicarbonate to correct acidosis |
| Sodium Kayexalate | Potassium binder |
| Laxative | Anti-constipation medication |
| Initial Assessment | 3 months post assessment | 9 months post assessment | |
| Weight (kg) | 30 | 30 | 29.5 |
| Height (cm) | 120 | 120 | - |
| Centile on the growth chart |
weight: 80th height: 8th |
weight: 74th height: 5th |
weight: 57th height: difficult to measure |
Calculation of estimated nutrition requirements:
Protein: 0.9-1 g/kg actual body weight (ABW) = 26.6 - 29.5 g
Energy: 50 kcal/kg ideal body weight (IBW) = 50 kcal x 20 kg = 1,000 kcal (requirement based on previous excessive weight gain)
Potassium: 1 mmol/kg ABW (1180 mg/29.5 mmol)
Phosphate: <400 mg/day (KDOQI, 2009)
| Biochemistry | Unit | Hospital Reference Range | Blood Results |
| Potassium (K+) | (mmol/l) | 3.6-4.8 | 5 ↑ |
| Phosphate (PO4 - ) | (mmol/l) | 1-2 | 1.38 |
| Urea | (mg/l) | 12-42 | 57 ↑ |
| Creatinine | (mg/dl) | 0.4-0.6 | 1.57 ↑ |
| GFR | (ml/min) | - | 44 |
| PTH | (ng/l) | 15-65 | 65 |
To control potassium and phosphate levels using dietary measures rather than medications as these were causing constipation.
Feeding plan:
Continuous tube feeding at 83 mls/hr x 12 hours
1,000 ml water at 83 mls/hr x 12 hours
Regime before using Renastart:
| Standard fibre containing tube feed | 1,000 mls |
| Powdered high energy protein feed | 30 g |
1 litre water (given separately)
Provides:
| Energy | 1,116 kcal |
| Protein | 26 g |
| K+ | 1,216 mg |
| PO4 - | 528 mg |
| Na | 640 mg |
| Fibre | 10 g |
Feeding plan:
Continuous tube feeding at 83 mls/hr x 12 hours
1,000 mls water at 83 mls/hr x 12 hours
Regime incorporating Renastart:
| Renastart | 105 g |
| Powdered protein supplement | 12.5 g |
| Infant formula | 98.9 g |
| Fibre supplement | 12.6 g |
(Made up to 1 litre)
Provides:
| Energy | 1,202 kcal |
| Protein | 28 g |
| K+ | 705 mg ↓ |
| PO4 - | 377 mg ↓ |
| Na | 428 mg ↓ |
| Fibre | 10 g |
| 11 months post assessment | |
| Weight (kg) | 29 |
| Height (cm) | 121 |
| Percentile on the growth chart |
weight: 55th height: 13th |
Changes to medications: Potassium and phosphate binders were stopped.
Laxative was stopped due to introducing another type of fibre mixture.
Biochemistry:
| Hospital Reference Range | Before | After | |
| K+ (mmol/l) | 3.6 - 4.8 | 5 ↑ | 3.8 |
| PO4 - (mmol/l) | 1 - 2 | 1.38 | 1.25 |
| Urea (mg/dl) | 12 - 42 | 57 ↑ | 45 |
| Creat (mg/dl) | 0.4 - 0.6 | 1.57 ↑ | 1.59 |
| GFR (ml/min) | - | 44 | 42 |
| PTH (ng/l) | 15 - 65 | 65 | 60 |
Potassium levels within normal hospital reference range after introducing Renastart.
Regular reviews were carried out by the dietitian and feeding regimen adjusted according to biochemistry.
- Renastart is specifically formulated for the dietary management of paediatric kidney disease.
- Renastart was successfully used with this patient to provide protein and calories and reduce dietary intake of potassium and phosphate.
- National Kidney Foundation 2009. KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update. American Journal of Kidney Diseases, 53, S1-S124.
