Table 1.

Effects of dietary supplementation, enteral feeding and specialist input by a dietician on growth

Study [reference]	No. of patients	Age (year)	GFR (mL/min/1.73 m2)	Diet	No. with nasogastric/no. with gastrostomy	Duration (months)	Growth
Improvement in growth overall
Guillot 1980 [9]	3	< 3		Energy 116% EAR, protein 84%	3/0	4–37	2 improved growth, 1 did not
Strife 1986 [10]	3	1.7–3.0	20–25	Starting with 50 kcal/kg and increasing	3/0	11–16	WtVel from < 5 to > 95%, HtVel from 5–40 to 80–95%
Rees 1989 [11]	16	0.2–1.8	7–37	100% RDA energy for CA, 100% RDA protein for Ht age	HtSDS improved in half 10/16 were tube fed: 6 improved their HtSDS. 60% of tube fed improved, 33% improved without tube	60	HtSDS − 2.9 (− 4.1 to − 1.5) At 1 year − 2.6 (− 4.3 to − 0.3) At 2 years − 2.4 (− 4 to 0) At 3 years − 2.0 (− 3.5 to − 0.1) at 5 years − 2.2 to − 0.2)
Brewer 1990 [12]	14	3 days to 3.1	PD	> 90% RDA energy for Ht age, 3–4 g/kg protein	13/0	3–33	Increase in HtSDS and WtSDS in 11
Claris-Appiani 1995 [13]	2 3	< 2 > 2	CRF	101–115% EAR energy, 75–113% protein	5/0	12	ΔHtSDS + 1.56, WtSDS + 1.72
Ledermann 1999 [14]	26 9	0–2 2–5	29 with GFR of 6–26, 6 on PD	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	20/9 8 Nissen	24	0–2-year group WtSDS − 3.1 to − 1.7 at 1 year, − 1.4 at 2 years, HtSDS − 2.9 to − 2.2 to − 2.1 2–5-year group WtSDS − 2.3 to − 2 at 1 year, − 1.1 at 2 years, HtSDS − 2.3 to − 2.0 to − 2.0
Kari 2000 [15]	24 13	0.3–2	< 20 PD	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	13/17 14 Nissen	≥ 24	HtSDS − 2.34 to − 1.93 HtSDS − 2.17 to − 1.24
Ledermann 2000 [16]	20	< 1	PD	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	10/8 7 Nissen	1–59	WtSDS − 1.6 at start, − 0.3 at 1 year, 0.3 at 2 years HtSDS − 1.8 to − 1.1 to − 0.8
Parekh 2002 [17]	17 7	< 1	< 65, polyuric PD	100–160 kcal and 2–2.5 g protein/kg/day, 2–4 mEq sodium, 0.3–0.5 kcal/mL	Both ? ratio	12–24	ΔHtSDS + 1.37 at 1 year, + 1.82 at 2 years
Norman 2004 [18]	25 21	2–16	51–75 25–50	Intensive input from dietician and supplementation if EAR energy and RNI micronutrients < 80%	0/1	24	All on supplements increased Ht and WtSDS No change in HtSDS if GFR > 50 HtSDS + 0.1 SD, correlation between intake and ΔHtSDS if GFR < 50
Hijazi 2009 [19]	52	4.4 range (0.5–18)	PD			1983–1995 N = 23 1996–2008 N = 29	Only data: − 3 ± 1.5 early era − 1.4 ± 0.9 second era
Mekahli 2010 [20]	101	0.3 (0–1.5)	< 20	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	Age at start of enteral feeds 0.8 years (0–4.9) At stop 2.5 (0.1–8.7) years 66% tube fed, 37% gastrostomy 13% Nissen	Up to 20 years	HtSDS (SD) − 0.42 (2.34) at birth (n = 40), − 2.07 (1.34) at 0.5 years (n = 57), − 1.93 (1.38) at 1 year (n = 72), − 1.14 (1.14) at 5 years (n = 67), − 1.04 (1.15) at 10 years (n = 62), − 1.84 (1.32) at 15 years (n = 40), − 1.68 (1.52) at 18 years of age (n = 32)
Sienna 2010 [21]	102	1.7 (0.9–15.6)	13.8 (3.9–61.8)		20 tube fed 82 demand fed	2.9 (0.9–11.8)	Mean BMISD (SD) – 1.22 ± 1.68 at start, 0.43 ± 0.86, at removal, 0.68 ± 1.23 at 5 years. Mean HtSDS 2.35 ± 1.86, – 1.51 ± 0.99, – 1.58 ± 1.64 Mean WtSDS − 2.53 ± 1.85, – 0.66 ± 0.97, – 0.16 ± 0.84 Controls over previous 5 years: Mean BMI (SD) 0.30 ± 1.47, 0.23 ± 2.62 Mean HtSDS 1.04 ± 1.38, – 1.17 ± 1.16 Mean WtSDS – 0.33 ± 1.48, – 0.30 ± 1.97 36% of the non-tube fed and 50% of those tube fed were overweight or obese, associated with steroid post-transplant
Rees 2011 [3]	153	< 2	PD		From diagnosis to last observation, 57 patients were fed on demand, 54 by NG and 10 by gastrostomy, 26 switched from NG to gastrostomy and 6 returned from NG to demand feeding		Median Δ BMISDS/year − 0.54 (1.91) during demand feeding vs + 0.97 (3.43) during NG tube feeding, + 1.24 (3.24) during gastrostomy feeding. Median Δ HtSDS/year − 1.35 (2.63) during demand feeding, − 0.72 (1.59) during NG tube feeding, − 0.50 (2.47) during gastrostomy feeding (p < 0.05 for gastrostomy vs. demand feeds)
Marlais 2019 [22]	50	2.1–10.9	1 HD, 15 PD 34 GFR 6–88	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	5 NG, 40 gastrostomy	24	Overall HtSDS improved from − 2.39 to − 2.27 at 1 year and − 2.18 after 2 years (p = 0.02). BMISDS − 0.72 to 0.23 after 1 year and 0.09 after 2 years (p < 0.0001). HtSDS improved more in children aged 2–6 years (− 2.13 to − 1.68, p = 0.03) and in children not on dialysis (− 2.33 to − 1.99, p = 0.002)
No change in growth rate
Ramage 1999 [23]	8 7	< 2.5 > 2.5	PD	Aiming for 100% RNI energy or greater if no response	0/12	12	Decline in HtSDS arrested No change
Coleman 1999 [24]	13	0.2–8.5	PD	5.9 and 3.1 dietician contacts/month	1/7	36	HtSDS from − 1.2 to − 1.14 and WtSDS from − 1.32 to − 0.73
Shroff 2003 [25]	18	0.5–2	HD	100% EAR energy for CA, 100% RNI protein for Ht age with protein supplement for PD	9/8	0.3–26	No change in HtSDS or WtSDS
Abitbol 1993 [26]	12	0.25–2	< 70	100% RDA energy, > 140% protein	9/3	Up to 24	Ht and WtVel lowest (− 2SD) by 6 months and Ht and WtSDS by 12 months of age, then stable at − 2SD
Deterioration in growth
Reed 1998 [27]	7	0.6 ± 0.7	Mean 17 (< 30)	Energy based on median Wt for CA	7/0	18.6 ± 4.5	HtSDS − 0.9 to − 1.1, WtSDS − 0.4 to − 0.2
Ellis 2001 [28]	137	< 5	PD/HD	Not specified	Equal at < 2 years, 29%/57% at 2–5 years	Until age 6 years	WtSDS − 0.77 at start, − 2.04 at 1 year, HtSDS − 1.75 and − 2.89 without supplements, WtSDS − 1.33 and − 1.70 and HtSDS − 1.76 and − 2.88 with supplements, respectively
Benefits of specialist input by a dietician
Norman 1998 [29]	2	0.25	PD	11.8 dietetic contacts/month predialysis, 8.4 during the first year on PD, 4.3 during the second year	Both gastrostomy	2	HtSDS increased from − 1.66 to − 0.17 and 0.67 to 0.78, WtSDS from − 1.26 to − 0.43 and 0.31 to 1.75
Coleman 1999 [24]	781 dietetic contacts during 182 patient-months	7.7 (range 0.2 to 8.5)	PD	Children < 5 years 5.9 (1.9) contacts/patient/month vs 3.1 (1.6) in children > 5 years of age	82% of contacts were with children receiving nutritional support via a button		Mean Ht and WtSDS were − 1.2 and − 1.32 at the start, and at the end were − 1.14 and − 0. 73, and BMISDS from − 0.91 to 0. 17

BMI, body mass index; CA, chronological age; CRF, chronic renal failure; EAR, estimated average requirement; GFR, glomerular filtration rate; HD, hemodialysis; Ht, height; NG, nasogastric; PD, peritoneal dialysis; RDA, recommended daily allowance; RNI, reference nutrient intake; SD(S), standard deviation (score); Vel, velocity; Wt, weight