Comparison of two protein diets in infants with chronic renal failure

Abstract •■ Objective: To compare the effects of two 6-month diet periods in achieving satisfactory growth in infants with chronic renal failure. Diet A consisted of human milk and diet B of a lower quantity of human milk supplemented with essential amino acids (EAA). •■ Design: Randomized trial using a cross-over design. •■ Setting: Nephrology clinic of a major pediatric tertiary referral center in Paris, France. •■ Participants: Sixteen infants (11 male) with an age range from 2 to 5 months. •■ Main outcome measures: Standard anthropometric measures, pertinent laboratory parameters, and serial nutritional intake data. •■ Results: The mean change in length over the study period did not differ between the two diet groups. Growth was better in infants on diet A. The mean weight for statural age showed a trend toward increasing during diet A. Standard laboratory parameters remained stable in both diet groups with the exception of plasma phosphate, which was decreased in infants on both diets, and plasma parathyroid hormone values, which varied in both diet groups. A nasogastric feeding regimen was instituated in 60% of the infants. The mean energy intake did not differ in the two diet groups and was 485 ± 16 kJ/kg body weight (BW) during diet A and 476 ± 7 during diet B. The mean protein intake expressed in g/kg BW was 1.9 during diet A and 1.2 during diet B (milk-EAA). •■ Conclusion: The low-protein diet supplemented with EAA showed neither advantage nor disadvantage over the human milk diet in growth in uremic infants. Human milk is particularly well adapted in uremia. Infants on both diets required phosphorus supplementation.