Nutritional Management of Hyperkalemic Infants With Chronic Kidney Disease, Using Adult Renal Formulas

Objective: This study sought to evaluate the use of adult renal formulas in hyperkalemic infants with chronic kidney disease (CKD). Design: This was a retrospective, single-center cohort study. Setting: This study took place at the Department of Pediatric Nephrology, Dialysis, and Transplantation at Helen DeVos Children's Hospital (Grand Rapids, MI). Patients: Seven hyperkalemic infants (mean age, 6.9 months) comprised the study population: 29% with stage 3 CKD, 29% with stage 4 CKD, and 42% with stage 5 CKD. Intervention: Infants were empirically treated with adult renal formulas for an average duration of 9.6 months. Six of seven infants were started on breast milk or infant formula (Similac PM 60/40, Abbott Laboratories, Columbus, OH), but because of inadequate growth and hyperkalemia, were transitioned to adult renal formulas (Suplena, Abbott Laboratories, Columbus, OH; Nepro, Abbott Laboratories, Columbus, OH; and/or Renalcal, Nestle Nutrition, Minnetonka, MN). One infant received adult renal formula at birth. Main Outcome Measures: The outcome measures included amount of potassium delivered by infant and adult renal formulas, level of serum potassium, and anthropometric measurements adjusted for age and gender (z-scores). Results: The transition from infant to adult renal formula resulted in a decrease in mean amount of potassium delivered by formula (from 2.6 to 1.0 mEq/kg/day, P < .001) and a decrease in mean serum potassium (from 5.1 to 4.0 mmol/L, P < .01). During treatment with adult renal formula, the infants demonstrated a significant increase in mean weight z-score (from -1.0 to 0.5, P < .01), height z-score (from -1.9 to -0.5, P<.01), and head-circumference z-score (from -1.5 to -1.0, P = .03). Adult renal formulas were well-tolerated. Conclusions: Hyperkalemic infants with CKD can be nutritionally managed on adult renal formula. (C) 2010 by the National Kidney Foundation, Inc. All rights reserved