Ten tips on how to optimize nutrition in children with chronic kidney disease or on dialysis

Abstract

ABSTRACT Optimal nutrition is central to growth and development in all children, and is particularly relevant in those with chronic illnesses. This document provides 10 practical, evidence-informed tips on the assessment and management of the nutritional prescription in children with chronic kidney disease (CKD) and those receiving dialysis. The 10 tips synthesize work of the Paediatric Renal Nutrition Taskforce, an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations for the nutritional management of children with kidney diseases. We describe a comprehensive, three-dimensional nutritional assessment (anthropometry, dietary intake, biochemical markers) and regular monitoring tailored to age, CKD stage and treatment modality. Energy prescriptions should approximate requirements of healthy peers, adjusting toward the upper end of the suggested dietary intake (SDI) for faltering growth, and accounting for dialysate-derived glucose in peritoneal dialysis (PD). Protein targets should align with the SDI, avoiding restriction to prevent impaired linear growth and protein-energy wasting; higher intakes are needed in children on PD to replace dialysate protein losses. Early, proactive strategies should address feeding barriers through fortification, oral supplements, timely initiation of enteral tube feeding and planning for gastrostomy insertion in patients on PD. A diet emphasizing fiber-rich, nutrient-dense foods is recommended, with individualized management of calcium, phosphate, potassium and sodium, and targeted micronutrient monitoring and supplementation. Reducing ultra-processed foods supports improved diet quality and mitigates cardiometabolic risk. Multidisciplinary care and ongoing outcome-focused research remain essential to refine nutritional targets and delivery approaches that optimize growth and long-term health in pediatric CKD.