Use of Renastart™ in a Child with CKD Stage 3 | Case Study

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A case study highlighting the use of Renastart™ in a child with Chronic Kidney Disease (CKD) stage 3.

The patient was a female aged 8 years and 10 months and had been diagnosed with CKD stage 3 due to bilateral dysplasia of the kidneys.


This information is intended for use by Healthcare Professionals only.

Renastart is a Food for Special Medical Purposes. Must be used under strict medical supervision with regular monitoring of nutritional status and electrolyte levels. For enteral use only. Not suitable as a sole source of nutrition.

Psychomotor retardation, failure to thrive, obesity, wheelchair bound, premature and dysmature, constipation, gastrostomy fed, no fluid restriction.

Medication Reason for Use
Calcium carbonate (CaCO3) Phosphate binder
Sodium bicarbonate (NaHCO3) Bicarbonate to correct acidosis
Sodium Kayexalate Potassium binder
Laxative Anti-constipation medication
  Initial Assessment 3 months post assessment 9 months post assessment
Weight (kg) 30 30 29.5
Height (cm) 120 120 -
Centile on the growth chart

weight: 80th

height: 8th

weight: 74th

height: 5th

weight: 57th

height: difficult to measure


Calculation of estimated nutrition requirements:

Protein: 0.9-1 g/kg actual body weight (ABW) = 26.6 - 29.5 g

Energy: 50 kcal/kg ideal body weight (IBW) = 50 kcal x 20 kg = 1,000 kcal (requirement based on previous excessive weight gain)

Potassium: 1 mmol/kg ABW (1180 mg/29.5 mmol)

Phosphate: <400 mg/day (KDOQI, 2009)

Biochemistry Unit Hospital Reference Range Blood Results
Potassium (K+) (mmol/l) 3.6-4.8 5  ↑
Phosphate (PO4- ) (mmol/l) 1-2 1.38
Urea (mg/l) 12-42 57 ↑
Creatinine (mg/dl) 0.4-0.6 1.57 ↑
GFR (ml/min) - 44
PTH (ng/l) 15-65 65


To control potassium and phosphate levels using dietary measures rather than medications as these were causing constipation.

Feeding plan:

Continuous tube feeding at 83 mls/hr x 12 hours

1,000 ml water at 83 mls/hr x 12 hours

Regime before using Renastart:

Standard fibre containing tube feed 1,000 mls
Powdered high energy protein feed 30 g

1 litre water (given separately)


Energy 1,116 kcal
Protein 26 g
K+ 1,216 mg
PO4- 528 mg
Na 640 mg
Fibre 10 g


Feeding plan:

Continuous tube feeding at 83 mls/hr x 12 hours

1,000 mls water at 83 mls/hr x 12 hours

Regime incorporating Renastart:

Renastart 105 g
Powdered protein supplement 12.5 g
Infant formula 98.9 g
Fibre supplement 12.6 g

(Made up to 1 litre)


Energy 1,202 kcal
Protein 28 g
K+ 705 mg  ↓
PO4- 377 mg  ↓
Na 428 mg  ↓
Fibre 10 g
  11 months post assessment
Weight (kg) 29
Height (cm) 121
Percentile on the growth chart

weight: 55th

height: 13th


Changes to medications: Potassium and phosphate binders were stopped.

Laxative was stopped due to introducing another type of fibre mixture.



  Hospital Reference Range Before After
K+ (mmol/l) 3.6 - 4.8 5  ↑ 3.8
PO4- (mmol/l) 1 - 2 1.38 1.25
Urea (mg/dl) 12 - 42 57 ↑ 45
Creat (mg/dl) 0.4 - 0.6 1.57  ↑ 1.59
GFR (ml/min) - 44 42
PTH (ng/l) 15 - 65 65 60


Potassium levels within normal hospital reference range after introducing Renastart.

Regular reviews were carried out by the dietitian and feeding regimen adjusted according to biochemistry.


  • Renastart is specifically formulated for the dietary management of paediatric kidney disease. 
  • Renastart was successfully used with this patient to provide protein and calories and reduce dietary intake of potassium and phosphate.
  1. National Kidney Foundation 2009. KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update. American Journal of Kidney Diseases, 53, S1-S124.