Tuokkola Jetta, Anderson Caroline E, Collins Sheridan, Pugh Pearl, Vega Molly R Wong, Harmer Matthew, Harshman Lyndsay A, Nelms Christina L, Toole Barry, Desloovere An, Paglialonga Fabio, Polderman Nonnie, Renken-Terhaerdt José, Shroff Rukshana, Snauwaert Evelien, Stabouli Stella, Walle Johan Vande, Warady Bradley A, Shaw Vanessa, Greenbaum Larry A
Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Pediatr Nephrol. 2025 May 17. doi: 10.1007/s00467-025-06759-5.
Children and young people with chronic kidney disease (CKD) are at risk for deficiency or excess of magnesium and trace elements. Kidney function, dialysis, medication, and dietary and supplemental intake can affect their biochemical status. There is much uncertainty about the requirements of magnesium and trace elements in CKD, which leads to variation in practice. The Pediatric Renal Nutrition Taskforce is an international team of pediatric kidney dietitians and pediatric nephrologists, formed to develop evidence-based clinical practice points to improve the nutritional care of children with CKD. PICO (patient, intervention, comparator, and outcomes) questions led the literature searches, which were conducted to ascertain current biochemical status, dietary intake, and factors leading to requirements differing from healthy peers, and to guide nutritional care of children with CKD stages 2-5, on dialysis, and post-transplantation. We address the assessment and intervention of magnesium and the trace elements chromium, copper, fluoride, iodine, manganese, selenium, and zinc. We suggest routine biochemical assessment of magnesium. Trace element assessment is based on clinical suspicion of deficiency or excess and their risk factors, including accumulation, losses, medications, nutrient interactions, and comorbidities. In particular, we suggest assessing magnesium, copper, iodine, and zinc when growth is poor, and evaluating magnesium, copper, selenium, and zinc in the presence of proteinuria. A structured approach to magnesium and trace element management, including biochemical, physical, and dietary assessment, is beneficial in the paucity of evidence. Research recommendations are suggested.
患有慢性肾脏病（CKD）的儿童和青少年存在镁及微量元素缺乏或过量的风险。肾功能、透析、药物治疗以及饮食和补充剂摄入都会影响他们的生化状态。CKD患者对镁和微量元素的需求量存在很大不确定性，这导致了实际操作中的差异。儿科肾脏营养工作组是一个由儿科肾脏营养师和儿科肾病学家组成的国际团队，其成立目的是制定基于证据的临床实践要点，以改善CKD儿童的营养护理。PICO（患者、干预措施、对照和结局）问题引导了文献检索，检索旨在确定当前的生化状态、饮食摄入以及导致需求与健康同龄人不同的因素，并指导2 - 5期CKD、透析及移植后儿童的营养护理。我们阐述了镁以及微量元素铬、铜、氟、碘、锰、硒和锌的评估与干预。我们建议对镁进行常规生化评估。微量元素评估基于对缺乏或过量及其风险因素的临床怀疑，包括蓄积、丢失、药物治疗、营养物质相互作用和合并症。特别是，我们建议在生长发育不良时评估镁、铜、碘和锌，在存在蛋白尿时评估镁、铜、硒和锌。在证据不足的情况下，采用结构化方法管理镁和微量元素，包括生化、体格和饮食评估，是有益的。文中还提出了研究建议。
