Long-term need and potential for withdrawal of enteral feeding in children with chronic kidney disease stage 5

Abstract Background Children with chronic kidney disease (CKD) stage 5 may require long-term enteral tube feeding. However, the factors associated with the need for tube feeding and the potential for its withdrawal are unclear. Methods This single-center, retrospective cohort study was conducted between 2004 and 2021 and included patients with CKD stage 5 aged < 18 years. We evaluated data on the initiation of enteral tube feeding and its associated factors, the potential and timing of the withdrawal of enteral tube feeding, and improvements in feeding difficulties before and after kidney transplantation. Results Of the 58 study participants, 33 (57%) received enteral tube feeding for more than 1 month. After adjusting for males and major congenital complications, logistic regression analyses identified a younger age at the initiation of kidney replacement therapy as a factor associated with the need for enteral tube feeding (odds ratio: 1.82, 95% confidence interval: 1.28‒2.56, P < 0.001). During the study period, enteral tube feeding was withdrawn from 24 of the 33 (73%) children (withdrawal rates: 2 years, 26%; 3 years, 50%; and 5 years, 66%). Of the nine patients in whom enteral tube feeding was not withdrawn before kidney transplantation, six underwent withdrawal at 0.1, 0.1, 1.1, 1.6, 2.9, and 3.3 years after kidney transplantation, respectively. The remaining three patients continued enteral tube feeding after kidney transplantation and are still under observation. Conclusions Although withdrawal from enteral nutrition is difficult in children with CKD stage 5, it may be possible with kidney transplantation or over time. Trial registration: Not applicable