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36 Dietary calcium intake is inadequate in the majority of children with chronic kidney disease
  1. Louise McAlister,
  2. Selmy Silva,
  3. Rukshana Shroff
  1. Great Ormond Street Hospital for Children


Introduction Adequate calcium (Ca) intake is required for bone mineralisation. KDOQI guidelines for CKD suggest a Ca intake between 100–200% of recommended intakes for healthy children, with an upper limit of 2500 mg/day in older children. We assessed Ca intake from diet, enteral feeds and medications in children with CKD3-5D and healthy controls.

Materials and methods 3-day food diaries were recorded in 23 children with CKD3-5, 23 CKD5D, 27 age-matched controls (median age 9.2 (range 0.8-17.8) years), including doses of phosphate binders and Ca supplements. Dietary Ca was calculated using standardised software.

Results Dietary Ca intake in CKD3-5D was 480 (131-836) vs 724 (218-1507)mg/day in controls (p=0.00002), providing 82% vs 108% (p=0.002) of the Reference Nutrient Intake (RNI) for age (figure 1). 74% of children with CKD3-5D received <100% RNI. 26% (12/46) of children with CK3-5D were exclusively enterally fed, achieving 90% RNI. The main Ca sources were dairy products (55% in controls vs 24% in CKD3-5D) and cereals (29% and 21% respectively). 80% (37/46) of CKD children were prescribed Ca-based phosphate binders, 15% Ca supplements and 11% both, increasing median daily Ca intake to 1145 (303-3779)mg/day, 177% RNI. When total daily Ca intake from diet and medications was considered, 7/46 (15%) received <100% RNI, 19 (41%) received >2 x RNI and 3 (6%) exceeded the KDOQI recommended upper limit of 2500 mg Ca/day. Adherence to the prescribed dose of medications was not assessed. 2 (28%) patients with a total Ca intake below the RNI were hypocalcaemic and one patient (5%) having >2 x RNI was hypercalcaemic.

Conclusions In children with CKD3-5D nearly 75% had a dietary Ca below 100% RNI for age. Restriction of dairy products as part of a phosphate controlled diet limits Ca intake. Additional calcium from medications is required in order to meet KDOQI’s guideline of 100-200% recommended intakes.

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