Principles and Efficiency of Differentiated Correction of Nutritional Disorders in Children with Chronic Kidney Disease

Abstract

Introduction. Modern assessment of nutritional status in children with CKD is based on a comprehensive system, not on the analysis of a single parameter. Anthropometry, clinical examination, dietary assessment, laboratory tests, and body composition methods should be interpreted together, as no single indicator covers all aspects of malnutrition. This is especially important in CKD, where fluid retention, inflammation, and hormonal changes can mask or, conversely, exaggerate individual signs of nutritional deficiency. The aim of the study. To develop the basic principles of differentiated correction of nutritional status disorders in children with chronic kidney disease and to evaluate their effectiveness. Materials and methods. A retrospective analysis of 63 medical records of children with CKD treated in the nephrology department of the National Children's Medical Center  (NCMC) clinic in 2022-2024 was conducted. Anamnesis data, anthropometry results, laboratory parameters (albumin, creatinine, calcium, phosphorus), assessment of kidney function, disease duration and the nature of the therapy were copied. A prospective examination of 61 children with CKD admitted to the department in 2024-2025, as well as 20 children in the control group. At this stage, a comprehensive clinical, laboratory and instrumental examination was conducted. which included bioimpedance analysis and an extended range of laboratory markers (prealbumin, retinol-binding protein, vitamins A, C, E, folic acid, trace elements, thyroid hormones, immunoglobulins). The effectiveness of the developed correction methods (including diet therapy, vitamin and mineral correction and, if necessary, pharmacological support) was assessed in 28 patients from the prospective group with a high risk of PEM (n=16) or existing PEM (protein-energy malnutrition) (n=12). Patients received comprehensive nutritional support according to the proposed principles for 6 months. The control group consisted of 20 patients from the retrospective group, comparable in baseline characteristics (CKD stage, age, gender), who received standard therapy without active nutritional support. Results and discussion. After 6 months of observation, positive dynamics of anthropometric parameters was noted in the main group. In the main group, a reliable increase in all anthropometric parameters was recorded: Z-score body weight/age increased by 0.38 SD (p=0.004), Z-score BMI/age – by 0.46 SD (p=0.002). Intergroup differences after 6 months are statistically significant for all parameters. The obtained results are consistent with modern foreign approaches, where prealbumin and parameters of body component composition are considered as sensitive markers of nutritional risk in patients with CKD. Conclusion. The principles of differentiated correction are proposed, including diet therapy with the choice of specialized mixtures depending on the stage of CKD, vitamin and mineral correction based on the identified deficiencies, as well as pharmacological support used when other methods are ineffective. The effectiveness of the proposed methods was demonstrated during prospective observation: 6 months after the start of the correction, a significant improvement in all nutritional status indicators was noted, and the incidence of protein-energy malnutrition decreased from 42.9% to 17.9% (NNT = 3.6).