Rahman Rehna K, Mattilda Annie, Iyengar Arpana
Department of Pediatric Nephrology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
Department of Nutrition, St. John's Research Institute, Bengaluru, Karnataka, India.
Indian J Nephrol. 2023 May-Jun;33(3):188-194. doi: 10.4103/ijn.ijn_149_21. Epub 2023 Feb 27.
Management of dietary phosphorus intake is a challenge in children with chronic kidney disease and is governed by regional food sources and culinary practices. The aim of this study was to evaluate dietary intake of phosphorus in these children and assess the utility of parental phosphate education for control of hyperphosphatemia.
This prospective study included children aged 2-18 years with CKD stages 2-5D. Phosphorus intake was assessed by 24-hour dietary recall, analyzed using food processor software, and interpreted based on dietary reference intake (DRI) and suggested dietary intake (SDI). Parents of those with hyperphosphatemia were subjected to a structured phosphate education, and serum phosphate was monitored every 2 months for 6 months.
Seventy children were recruited (mean age 9.4 ± 3.4 years, CKD5/5D: 51% ( = 36)) with median duration of CKD being 3.8 (IQR2,6) years. In the overall cohort, 50% (35/70) had phosphorus intake exceeding DRI with no significant difference between groups [CKD 5/5D,52.7% ( = 19) vs CKD2-4 47% ( = 16), = 0.63]. Mean daily phosphorus intake was comparable between children with and without hyperphosphatemia [908 ± 279 mg vs 814 ± 302 mg, = 0.1]. Based on DRI, 44% of children with normal serum phosphate and 58% with hyperphosphatemia had increased dietary intake of phosphorus ( = 0.15). Based on SDI, 26% with normal serum phosphate and 94% with hyperphosphatemia had increased dietary phosphorus intake ( < 0.001). Hyperphosphatemia was observed in 51% (CKD 2-4); 33% CKD5-5D 66%, = 0.6). Among 29 children completing 6 months of follow up, there was a significant reduction in mean serum phosphate levels ( = 0.001) which was independent of age, stage of CKD or intake of phosphate binders. At end of the study, hyperphosphatemia persisted in 34%.
Compared to DRI, dietary assessment of phosphorus intake based on SDI was significantly associated with hyperphosphatemia in children with CKD 2-5D. In the majority, repeated parental structured phosphate education over 6 months was useful in managing hyperphosphatemia.
对于慢性肾脏病患儿而言，控制膳食磷摄入量是一项挑战，这受到地区食物来源和烹饪习惯的影响。本研究的目的是评估这些患儿的膳食磷摄入量，并评估家长接受磷教育对控制高磷血症的效用。
这项前瞻性研究纳入了2至18岁的2-5D期慢性肾脏病患儿。通过24小时膳食回顾评估磷摄入量，使用食物处理软件进行分析，并根据膳食参考摄入量（DRI）和建议膳食摄入量（SDI）进行解读。对高磷血症患儿的家长进行结构化的磷教育，并每2个月监测血清磷水平，持续6个月。
共招募了70名患儿（平均年龄9.4±3.4岁，5/5D期慢性肾脏病患儿占51%（n = 36）），慢性肾脏病的中位病程为3.8（IQR 2,6）年。在整个队列中，50%（35/70）的患儿磷摄入量超过DRI，各亚组之间无显著差异[5/5D期慢性肾脏病患儿，52.7%（n = 19）；2-4期慢性肾脏病患儿，47%（n = 16），P = 0.63]。高磷血症患儿与非高磷血症患儿的平均每日磷摄入量相当[908±279mg对814±302mg，P = 0.1]。根据DRI，血清磷正常的患儿中有44%、高磷血症患儿中有58%的膳食磷摄入量增加（P = 0.15）。根据SDI，血清磷正常的患儿中有26%、高磷血症患儿中有94%的膳食磷摄入量增加（P < 0.001）。2-4期慢性肾脏病患儿中高磷血症的发生率为51%；5-5D期慢性肾脏病患儿中为33%（66%，P = 0.6）。在完成6个月随访的29名患儿中，平均血清磷水平显著降低（P = 0.001），这与年龄、慢性肾脏病分期或磷结合剂的摄入量无关。研究结束时，34%的患儿仍存在高磷血症。
与DRI相比，基于SDI的膳食磷摄入量评估与2-5D期慢性肾脏病患儿的高磷血症显著相关。在大多数情况下，家长在6个月内反复接受结构化的磷教育对控制高磷血症有效。
