The CARI Guidelines – Caring for Australians with Renal Impairment Nutrition and Growth in Kidney Disease (December 2005) Evaluation and management of nutrition in children Date written: May 2004 Final submission: January 2005 Author: Elisabeth Hodson GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions are based on Level III and IV sources) • Measurements should be made at 1–3 month intervals of supine length or standing height and weight with comparison to normal values for chronological age using percentile charts, standard deviation scores (SDS) and body mass index (BMI). • Nutrition assessment and counselling should take place at 1–3 month intervals. • Serum albumin should be measured at 1–3 month intervals. • Calculations of protein equivalent of nitrogen appearance (nPNA) are not reliable measures of dietary protein intake in children and should not replace nutritional assessment. Background Children with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) frequently have growth retardation. Infants in particular, may demonstrate rapid falls in length SDS in the first 6 months of life, with little catch-up subsequently. Height, weight, head circumference, skinfold thicknesses and serum albumin are commonly used as markers of nutrition in children with CKD or ESKD. Nutritional assessment and counselling is regarded as mandatory in the management of children with CKD and ESKD, although it has proven difficult to find objective data to support this. The objectives of this guideline are to review the available evidence for appropriate nutritional markers and for the value of nutritional assessment and counselling in children with CKD or ESKD.