1998 Global Conference Proceeding

March 02 - 04, 1998

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Conference: 1998 Global Conference
Title: Nutritional Concerns for Persons with NDI
Author: Trahms, Cristine
Institution: University of Washington
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Abstract • Translation

The nutritional goals for the treatment of NDI are to promote normal growth and development by:

  1. Providing an adequate intake of energy and nutrients.
  2. Minimizing the renal solute load by restriction of sodium and protein.
  3. Providing adequate water to avoid dehydration.
  4. Providing supplemental potassium, as necessary.

In our clinical experience, the 'usual' components of the prescription that meets these objectives are: 1) energy- 100-150 kcal/kg, depending on age and growth pattern, 2) protein- 2 grams/kg; and 3) sodium- 300-500 mg/day. Response to treatment for NDI depends on the three components of treatment: 1) diuretic prescription and use, 2) adherence to prescribed sodium restriction, and 3) adherence to prescribed protein restriction. Effective treatment, that is decreased urine volume and appropriate physical growth, requires all three components of treatment.

The nutritional concerns in infancy are focused on providing breast feeding or a lower sodium infant formula and meeting energy needs to support growth. The nutritional concerns in childhood are primarily meeting energy needs to support growth while maintaining sodium and protein restrictions and meeting calcium and iron needs.

In our clinical experience growth patterns for children with NDI may be slower depending on the timing of the start of treatment and adherence to it. Although puberty may be delayed, with effective management eventual physical growth (stature) is expected to be 'familial'.

There are a series of age appropriate tasks that support first compliance and then adherence to the rigors of NDI treatment. These tasks are first parent responsibilities and then transferred to the individual with NDI for long-term management. The primary tasks are: 1) developing low sodium food habits, 2) developing self-management skills in food choices and medication management, and 3) developing skills in reading labels and using the information to make effective choices.

Nephrogenic diabetes insipidus (NDI) patients have distinct nutritional needs. They must receive an adequate intake of energy, nutrients and water, restrict their sodium and protein intake, and, when necessary, receive supplemental potassium. The energy value of the food children with NDI consume should average between 100 -150 food calories per kilogram, depending on age and growth cycle. Their protein intake should average two grams for every kilogram they weigh. Sodium intake should be restricted to 500 mg per day. NDI patients must adhere to these restrictions as well as take the proper diuretic prescription if they wish to reduce urine volume and achieve appropriate physical growth. During infancy, the patient should be assured the food energy necessary to support growth and either be breast-fed or placed on a low sodium infant formula. During childhood, the focus is on meeting his growing food energy, calcium and iron needs while maintaining sodium and protein restrictions. Parents must train their child with NDI to follow his diet, be able to read food labels and make the proper food choices, and to be able to self-manage his medication. If all this can be accomplished, the child, while his growth may be slower and puberty may be delayed, can be expected to reach a level of physical growth considered normal in relation to his family heritage.