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 4.0mmol/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.