title: Comparison of two micronutrient supplements in children with chronic renal failure.
abstract: OBJECTIVE
  To compare a newly formulated renal-specific micronutrient (RSM) supplement (vitamins C, E, K, and B complex, copper, zinc) with Ketovite (Paines & Byrnes, Middlesex, UK) tablets (vitamins C, E, K, and B complex) in children with chronic renal failure (glomerular filtration rate [GFR] < 25 mL/min/1.73 m(2)) or on chronic peritoneal dialysis (CPD) and hemodialysis (HD).
  
  
  METHODS
  Children currently prescribed Ketovite tablets were changed to RSM for 3 months. Questionnaires on palatability, acceptability, and ease of administration were assessed while on Ketovite and after 3 months on RSM along with plasma levels of zinc, copper, folate (serum, red cell), vitamin B(12), and homocysteine.
  
  
  METHODS
  Regional pediatric nephrology unit.
  
  
  METHODS
  Fifteen children (10 male) with a mean age of 10.4 years (range, 1.1 to 16 y) were recruited (11 had GFR < 25 mL/min/1.73 m(2), 2 CPD, 2 HD). Two children received overnight gastrostomy button feeding.
  
  
  METHODS
  Fourteen children (1 child refused RSM after 1 week) and their families completed questionnaires using a Likert scale: 1 (liked) to 7 (disliked). Plasma levels were analyzed at baseline on Ketovite and after 3 months on RSM.
  
  
  RESULTS
  Children disliked the smell of Ketovite compared with RSM (P =.004). The size of Ketovite was preferable to the size of the RSM (P =.015) and was believed to be easier to administer (P =.046). There were no differences in patient/parent rating of appearance, texture, or taste, but 8 of 15 patients (53%) expressed a preference for the RSM if available. Plasma values of copper, zinc, folate, and vitamin B(12) were within the normal reference range on Ketovite and showed no significant change on RSM. Mean plasma homocysteine levels were above normal reference ranges in all groups (GFR < 25 mL/min/1.73 m(2), 7.6 [SD, 3.1]; CPD, 11.5 [SD, 1.6]; HD, 12 [SD, 8.7]) on Ketovite and were unchanged after 3 months on RSM.
  
  
  CONCLUSIONS
  This pilot study confirms the acceptability of the RSM, particularly in relation to its smell and chewability, but the current size may preclude its widespread use. The incorporation of zinc and copper will be beneficial for many children, but reduction in homocysteine levels may necessitate an increase in folic acid content.
authors.affiliation: Department of Dietetics and Nutrition, Nottingham City Hospital NHS Trust, Nottingham, UK.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Coleman
authors.forename: Alan R
authors.initials: AR
authors.lastname: Watson
authors.forename: Shefali
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Deborah
authors.initials: D
authors.lastname: Thurlby
authors.forename: Jean
authors.initials: J
authors.lastname: Wardell
mesh_terms: D000293:Adolescent; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage* / Q000097:blood; D008903:Minerals / Q000008:administration & dosage / Q000097:blood; D009752:Nutritional Status; D009812:Odorants; D010530:Peritoneal Dialysis; D010865:Pilot Projects; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D013649:Taste; D014131:Trace Elements / Q000008:administration & dosage / Q000097:blood; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood
chemical_list: D018977:Micronutrients; D008903:Minerals; D014131:Trace Elements; D014815:Vitamins; D006710:Homocysteine; D005492:Folic Acid