ESPN 53rd Annual Meeting

ESPN 2021


 
The effects of potassium and phosphate binders added to first age formula: an interest in infants with chronic kidney disease
ROUBA BECHARA 1 VERONIQUE CHAMBON 1 CORENTIN NAUD 1 BRUNO RANCHIN 1 JUSTINE BACCHETTA 1

1- HOSPICES CIVILS DE LYON, LYON, FRANCE
 
Abstract:

 

Background

In infants with chronic kidney disease (CKD), even more than in older children, nutrition and growth are complex entities. Management of hyperkalemia and hyperphosphatemia is challenging, and the use of potassium and phosphate binders directly in formulas may be useful, avoiding direct ingestion of resins by infants.  

Materials and methods

Gallia® 1st age milk was studied. For 90 mL of formula, we added either carbonate sevelamer (Renvela®, 200, 400 or 800mg) or polystyrene sulfonate (Resikali®, 2000, 4000 or 8000mg). We also evaluated the combined use of the resins: in 90 mL we added 200mg/2000mg, 400mg/4000mg, and 200mg/4000mg of Renvela® and Resikali®, respectively. Milks were decanted for 10 minutes; the supernatants were then weighted and analyzed for osmolarity and pH. After centrifugation sodium, potassium, chlore, bicarbonate, magnesium, glucose, calcium, phosphate, protein, cholesterol, triglycerides, iron, folate, vitamin B12 levels were assessed.

Results

Potassium levels decreased in milk in a dose-dependent manner with polystyrene sulfonate, by 36, 52 and 68%, respectively. Polystyrene sulfonate reduced magnesium levels and increased both calcium concentration (from 9.7 to 21 mmol/L) and osmolarity (from 359 to 423 mOsm/kg). No effect on phosphate was observed. Sevelamer reduced both calcium and phosphate concentrations, in a dose-dependent manner: by 14, 26 and 29%, and by 24, 36 and 40%, respectively. Sevelamer increased pH from 6.9 to 9.1, and also decreased folate levels by 32, 66 and 81% respectively, from 465 to 88 mmol/L. The combined use of sevelamer and polystyrene sulfonate decreased both potassium (by 45, 59 and 59%, respectively), phosphate (by 38, 39 and 36%, respectively), and folate levels, however with a slighter pH increase. Osmolarity was unchanged. No other relevant differences were observed.

Conclusion

Pretreating formulas by resins is reproducible and simple when specific diets for CKD are not available. However, resins may impact the global composition (osmolarity) and other nutrients (folates).