Аннотация
INTRODUCTION AND AIMS: Disorder of nutritional status and protein-energy malnutrition (PEM) is common and serious complication of chronic kidney disease (CKD) in children. The main objective of study is to evaluate an effectiveness of usage of specialized nutritional formula for the correction of disorders of nutritional status in children with CKD in pre-dialysis stage in order to slow the progression of renal disease. METHODS: The study included 20 children with CKD in pre-dialysis stage at the age of 1 month to 16 years. In the structure of diseases that leaded to CKD were congenital anomalies of urinary system and the following: obstructive uropathy in 9 cases (45%), VUR (vesico-ureteric reflux) with reflux nephropathy in 8 cases (40%), renal hypoplasia in 2 cases (10%) and 1 case (5%) of KSD (kidney stone disease) with calculous pyelonephritis. In 12 children third stage of CKD was diagnosed: creatinin within 60-110 (82,2 ±16,1 ) umol\L, GFR 44,9 ±9,43 ml\min. In 8 children with 4th stage of CKD: creatinin 177,7 ±42,0 umol\L, GFR 19,1 ±5,27 ml\min. In order to study the nutritional status the laboratory methods of evaluation were used - albumin level and transferring level in blood. The study lasted 12 weeks, including period of test dosing of nutritional formula - 2 weeks (in department), period of initial evaluation of effectiveness and safety - 10 weeks (outpatiently: nutritional formula and bars). Before the study all patients had disorders of nutritional status, decrease of indexes of physical growth and development. Dose of nutritional formula (NF) of “NutrienNefro” was based on daily protein requirements. Children older than 3 years administrated NF in a form of cocktail or a bar. For the children up to 1 year required quantity of NF was added to each feeding during a day. Generally, tolerability of diet with NF was satisfactory. RESULTS: Against the background of disorders of nutritional status in children with 3rd stage of CKD there was a significant increase of albumin level from 31,5 ±1,78 to 39,8 ± 3,43 g\L (p<0,05) and increase of transferring level from 168,5 ± 3,60 to 197,4 ± 6,66 mg\dl. Children with 4th stage of CKD changes of indexes a little bit less, but in comparison with initial data they had positive dynamics. The level of albumin was 28,6 ± 1,68 g\L and against background of NF it was 36,5 ± 1,60 g\L, also, the level of transferring 162,0 ± 3,46 to 190,3 ± 5,57 mg\dl (p<0,05). Important thing in this study is improvement of kidney function in children with 3 - 4 stages of CKD. So, in children with 3rd stage of CKD the initial GFR was 44,9 ±9,43 ml\min and after 12 weeks of administration of NF it has been increased from 61,1 ±8,19 (p<0,05) and with 4th stage - 19,1 ± 5,27 to 35,5 ± 8,14 ml\min, correspondingly (p<0,05). CONCLUSIONS: Adding to a diet of high-energy nutritional formula allows to correct adequately the disorders of nutritional status and provides prevention of PEM in children with CKD in pre-dialysis stage with decrease of progression of renal disease, improving the quality of life and removal of dialysis therapy.