Use of Renastep™ in End Stage Renal Disease and PD | Case Study
DESCRIPTION
Case study describing the use of Renastep as an oral nutritional supplement for a child with end stage renal disease on peritoneal dialysis.
Notes:
This information is intended for use by Healthcare Professionals only.
Renastep is a Food for Special Medical Purposes.
Age: 5 years 2 months
Gender: Female
Diagnosis: End stage renal disease (ESRD) due to Wilm’s Tumour
Relevant medical history: Wilm’s Tumour, bilateral nephrectomies, peritoneal dialysis, hypertension, constipation.
Relevant medications: Calcium carbonate (phosphate binder). Lactulose, senna and sodium picosulphate (to treat constipation).
| Biochemistry | K+ (mmol/l) | PO4 (mmol/l) | Urea (mmol/l) | Albumin (g/l) |
| Before starting Renastep | 4.8 | 2.4↑ | 14.4↑ | 39 |
| Recent | 4.8 | 1.4 | 19.1↑ | 38 |
| Hospital reference ranges | 3.5-5.0 | 0.8-1.9 | 1.7-8.3 | 40-52 |
Fluid restriction: 300mls per day
| Date | Pre Renastep (January 2018) | Recent anthropometry (April 2019) |
| Weight (kg) | 11.05 kg | 13.85 kg |
| Height (cm) | 87 cm | 95.6 cm |
| Percentile on the growth chart |
Weight (<0.4th centile) Height (<0.4th centile) |
Weight (1st centile) Height (<0.4th centile) |
Calculation of nutritional requirements:
Energy: 1170 - 1390 kcal per day1
Protein: 1.3 g/kg/day2 = 14.4 g per day
Dietary intake:
Dietary intake was variable – intake decreased significantly when unwell and during hospital admissions
Breakfast: 1 slice of toast with butter and/or 1 croissant.
Lunch: 1 egg sandwich, 1 apple, 1 small fromage frais yoghurt.
Dinner: 2-3 slices of toast with butter or 1 egg sandwich.
Snack: 2-3 plain biscuits, 1 packet of corn crisps.
Estimated dietary intake:
1000 - 1100 kcals/day
20 g/day protein
Oral nutritional supplements prior to commencing Renastep:
Three different energy supplements providing in total: 594 kcal, 8.4 g protein, 8.3 mmol potassium, 5.7 mmol phosphate and 240 mls water.
Current oral nutritional supplements:
Renastep x 3 bottles per day providing:
750 kcals, 15 g protein, 3.3 mmol potassium, 4.2 mmol phosphate and 240 mls water
The patient’s growth, intake of food and Renastep are reviewed regularly during her peritoneal dialysis outpatient clinic appointments. Her weight has increased from below the 0.4th centile to the 1st centile and her blood phosphate levels are now within the normal reference range.
Renastep was successfully used with this fluid restricted patient receiving peritoneal dialysis to provide additional calories within her fluid restriction. Her blood phosphate levels also improved.
Renastep was accepted and well tolerated by the patient who continues to take 3 bottles per day 15 months after the initial prescription was commenced.
Due to its’ low potassium content, Renastep is beneficial for use in paediatric renal patients with ESRD, treated either conservatively or with dialysis, where additional calories are required. In particular it is very useful when these patients are fluid restricted to help optimise their calorie intake as the water content of this supplement is only ~80 mls per bottle.
Also, the potassium content of Renastep is approximately 7 to 8 times lower than the current available standard paediatric compact oral nutritional supplements. As a result Renastep is a useful product for paediatric renal patients where additional calories are required without negatively impacting on their blood potassium and phosphate levels.
- Scientific Advisory Committee on Nutrition (SACN). (2011) Dietary Reference Values for Energy. London: The Stationery Office.
- Royle J (2015) In: Clinical Paediatric Dietetics, 4th edition, Chapter 12: Kidney Disease. Wiley Blackwell, editor Shaw V, p. 242-281.
