Growth Failure in Children 

with Kidney Disease 

How do the kidneys affect a 

child’s growth? 

In addition to removing wastes and extra 

fluid from the blood, the kidneys perform 

several functions important for a child’s 

growth, including 

n	 helping regulate the amounts and interactions of nutrients from food, including minerals like calcium, phosphorus, 

and vitamin D 

n	 maintaining the proper acid-base balance in the blood 

n	 producing the hormone erythropoietin 

(EPO), which promotes red blood cell 

production 

n	 playing a possible role in the metabolism of growth hormone, also called 

somatotropin 

Calcium and vitamin D are essential for 

normal bone growth. The kidneys turn 

vitamin D into an active hormone called 

calcitriol that helps bones absorb the right 

amount of calcium from blood. The kidneys also eliminate excess phosphorus. If 

the kidneys are impaired, bones do not 

get enough calcium either because the kidneys fail to turn vitamin D into calcitriol 

or because they let too much phosphorus 

build up in the blood. The excess phosphorus draws calcium into the blood and 

blocks calcium from getting to the bones. 

How is growth failure treated? 

The child’s doctor may recommend a number of strategies to treat growth failure. 

Low-phosphorus Diet 

Dietary changes involve limiting foods that 

are high in phosphorus, like milk and other 

dairy products. Cream cheese and cottage cheese are acceptable low-phosphorus 

dairy foods. High-phosphorus foods also 

include meat, fish, and poultry and some 

vegetables like broccoli, peas, and beans. 

Dark breads, like whole wheat and pumpernickel, and many cereals are also high in 

phosphorus. Because avoiding all of these 

foods is almost impossible, caregivers must 

Learning the phosphorus content of foods and measuring portions can help control phosphorus intake. 

U.S. Department of Health
 

and Human Services
 

National Kidney and Urologic Diseases 

NATIONAL INSTITUTES OF HEALTH Information Clearinghouse
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

work with a dietitian to find a healthy way to limit 

phosphorus in the child’s diet while still providing 

enough calories and other nutrients for growth and 

health. Learning the phosphorus content of foods 

and measuring portions can help control phosphorus 

intake. 

Phosphate Binders 

In addition to limiting phosphorus in the child’s diet, 

the doctor may recommend a phosphate binder. 

This medicine binds some of the phosphorus in the 

bowel so that it is excreted in the child’s stool. Phosphate binders come in the form of chewable tablets, 

liquids, capsules, and pills. Some children can use 

over-the-counter antacid tablets as phosphate binders 

because they contain calcium. A calcium-free binder 

may be prescribed if calcium buildup in the blood 

is a concern. The child should take the phosphate 

binder with meals and only according to the doctor’s 

recommendations. 

Nutritional Supplements 

Children with advanced kidney disease may lose 

their appetite or lack the energy to eat. These children may need nutritional supplements to support 

growth. In some cases, tube feeding is required. 

While drastic, tube feeding is often the best way 

to ensure a child gets the full supply of fluid and 

nutrients needed to promote growth and development. Feeding tubes are most often used in infants, 

but sometimes older children and adolescents benefit from them as well. See the fact sheet Nutrition 

in Children with Chronic Kidney Disease from the 

National Kidney and Urologic Diseases Information 

Clearinghouse (NKUDIC) for more information. 

Calcitriol and Other Vitamin D Medications 

Children with chronic kidney disease may also need 

to take a synthetic form of calcitriol or a similar vitamin D medication to help the bones absorb calcium 

and help build bones. These medications also help 

in the growth process. These supplements may be 

administered by injection or taken orally in pill form. 

Children with chronic kidney disease may need to take a synthetic 

form of calcitriol or a similar vitamin D medication. 

Alkaline Agents 

The doctor may prescribe sodium bicarbonate or 

some other alkaline agent to restore the acid-base 

balance in a child with acidosis—high levels of acid 

in the blood. Acidosis resulting from chronic kidney 

disease can disrupt growth. 

Erythropoietin (EPO) 

Children with chronic kidney disease may develop 

anemia. Anemia is the shortage of red blood cells, 

which deliver oxygen throughout the body. Lack of 

oxygen can lead to fatigue and poor growth. The 

kidneys support the production of red blood cells by 

making the hormone EPO. Kidney disease decreases 

the production of EPO, causing anemia. The doctor 

may prescribe a man-made form of EPO given by 

injection to treat this problem. 

Growth Hormone 

If the child is very short as a result of kidney disease, some doctors prescribe injections of human 

growth hormone. Almost all pediatric nephrologists 

believe that the availability of growth hormone has 

been an important advance in the treatment of small 

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children with chronic kidney disease. Most studies suggest that growth hormone stimulates growth 

in children with chronic kidney conditions or children undergoing maintenance dialysis treatment or 

transplantation. 

Points to Remember 

n	 The kidneys play an important role in a child’s 

growth. 

n	 The kidneys help regulate the amounts and interactions of nutrients from food, including minerals 

like calcium, phosphorus, and vitamin D, that are 

necessary for growth. 

n	 If the kidneys are impaired, bones do not get 

enough calcium either because the kidneys fail to 

turn vitamin D into calcitriol or because they let 

too much phosphorus build up in the blood. 

n	 Growth failure is treated with 

– low-phosphorus diet 

– phosphate binders 

– nutritional supplements 

– calcitriol and other vitamin D medications 

– alkaline agents 

– erythropoietin (EPO) 

– growth hormone 

Hope through Research 

The National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK) conducts and supports research to help people of all ages with kidney 

disease. The NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases (KUH) maintains 

the Pediatric Nephrology Program, which supports 

research into the causes, treatment, and prevention 

of kidney disease in children. In 2003, the KUH 

division began the Prospective Study of Chronic 

Kidney Disease in Children to learn more about the 

negative effects of pediatric kidney disease, including cardiovascular disease and growth failure. That 

study is ongoing. 

Participants in clinical trials can play a more active 

role in their own health care, gain access to new 

research treatments before they are widely available, 

and help others by contributing to medical research. 

For information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

American Kidney Fund 

6110 Executive Boulevard, Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 or 301–881–3052 

Email: helpline@kidneyfund.org 

Internet: www.kidneyfund.org 

American Society of Pediatric Nephrology 

3400 Research Forest Drive, Suite B7 

The Woodlands, TX 77381 

Phone: 281–419–0052 

Fax: 281–419–0082 

Email: info@aspneph.com 

Internet: www.aspneph.com 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Fax: 212–689–9261 

Internet: www.kidney.org 

Acknowledgments 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists and 

outside experts. The NKUDIC would like to thank 

Barbara Fivush, M.D., and Kathy Jabs, M.D., of the 

American Society of Pediatric Nephrology (ASPN), 

for coordinating the review of the original version of 

this publication by the ASPN’s Clinical Affairs Committee: Tej Mattoo, M.D.; William Primack, M.D.; 

Joseph Flynn, M.D.; Ira Davis, M.D.; Ann Guillott, 

M.D.; Steve Alexander, M.D.; Deborah Kees-Folts, 

M.D.; Alicia Neu, M.D.; Steve Wassner, M.D.; John 

Brandt, M.D.; and Manju Chandra, M.D. Frederick 

Kaskel, M.D., Ph.D., president, ASPN, and Sharon 

Andreoli, M.D., secretary-treasurer, ASPN, also provided comments and coordination. 

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You may also find additional information about this 

topic by 

•	 searching the NIDDK Reference Collection at 

www.catalog.niddk.nih.gov/resources

•	 visiting MedlinePlus at www.medlineplus.gov

This publication may contain information about medications. When prepared, this publication included 

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information. 

National Kidney and Urologic 

Diseases Information Clearinghouse 

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov 

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes 

of Health of the U.S. Department of Health 

and Human Services. Established in 1987, 

the Clearinghouse provides information 

about diseases of the kidneys and urologic 

system to people with kidney and urologic 

disorders and to their families, health care 

professionals, and the public. The NKUDIC 

answers inquiries, develops and distributes 

publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about 

kidney and urologic diseases. 

This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate 

and distribute as many copies as desired. 

This fact sheet is also available at 

www.kidney.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 09–4569 

January 2009