Renastep™

• Renastep has been designed specifically for children with kidney disease in conjunction with key Healthcare Professionals working within this specialism.
• Renastep has a flexible use and can be used in varying amounts in conjunction with other paediatric enteral feeds and / or oral diet to meet individual nutritional requirements.
• Renastep can be administered as a tube feed or taken orally. It can also be added to various foods and drinks. Recipes are available on request.
• Renastep is high in energy (2kcal/ml) which is of high importance for those who are on a fluid restriction¹.
• Renastep has a tailored level of protein (2g/100kcal) to ensure protein requirements are met to optimise growth, without exceeding requirements.
• Renastep has a tailored micronutrient content specific for children from 3 years of age onwards with kidney disease.
• Renastep has low levels of potassium and phosphorus compared to standard paediatric enteral feeds to facilitate dietary restrictions which are commonly needed in the management of kidney disease.
• Renastep has low levels of calcium compared to standard paediatric enteral feeds to allow the use of calcium-based phosphate binders².
• Renastep has a low level of vitamin A compared to standard paediatric enteral feeds, to ensure vitamin A toxicity is avoided, a complication often associated with this condition³.
• Renastep comes in a ready to use format reducing the complexity and preparation errors associated with powdered products and reducing the burden for caregivers⁴.
• Renastep has a mild vanilla flavour which takes into account the taste changes associated with kidney disease⁵
• Renastep is packaged in a 125ml bottle which is convenient and portable.

1. Tsai, Y.-C., et al., Association of fluid overload with kidney disease progression in advanced CKD: a prospective cohort study. American Journal of Kidney Diseases, 2014. 63(1):
2. National Kidney Foundation, KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update. American Journal of Kidney Diseases, 2009. 53(S2): p. S1-S124.
3. Manickavasagar, B., et al., Hypervitaminosis A is prevalent in children with CKD and contributes to hypercalcemia. Pediatric Nephrology, 2015. 30(2): p. 317-25.
4. Evans, S., et al., Nutritional content of modular feeds: how accurate is feed production? Archives of Disease in Childhood, 2013. 98(3): p. 184-8.
5. Armstrong, J.E., et al., Smell and taste function in children with chronic kidney disease. Pediatric Nephrology, 2010. 25(8): p. 1497-1504.

Dietary management has a key role in the management of both acute kidney injury (AKI) and chronic kidney disease (CKD).¹

Protein energy wasting (PEW) has been described in 20-40% of patients with CKD stages 4-5² and in 28%-54% of dialysis patients.³ Poor energy and protein intakes are more common when the glomerular filtration rate (GFR) falls below 25ml/min⁴ due to symptoms such as uraemia, nausea, taste changes and tiredness.

Hyperkalaemia and hyperphosphatemia become increasingly common as GFR falls¹ and thus low potassium, low phosphate dietary restrictions may be needed.¹ Hyperkalaemia can develop as early as CKD stage 3 and can be life threatening.¹ Medical and dietetic management, including a low potassium diet, are needed to keep serum potassium levels within reference range.

Renastep is a food for special medical purposes for the dietary management of kidney disease from 3 years of age onwards.

• Renastep can be used to help meet energy and protein requirements whilst managing potassium and phosphorus intake.
• One bottle (125ml) of Renastep provides 250kcal and 5g protein.
• The high energy (2kcal/ml) and tailored protein content of Renastep are also useful for those on a fluid restriction and those with uraemia.
• Renastep has a lower level of potassium and phosphorus compared to non-renal specific adult ONS to ensure potassium and phosphorus intake can be limited.
• Renastep also has a lower level of calcium when compared to non-renal ONS to enable the use of calcium-based phosphate binders, a practice used to manage high serum phosphate levels.¹
• Altered vitamin A homeostasis is seen in adults with CKD and chronically elevated plasma retinoid levels have been associated with osteoporosis/osteopenia, dyslipidemia and cardiac events.⁵ Renastep has a lower level of vitamin A compared to non-renal ONS to help reduce the risk of these issues.
• Renastep can be used in AKI, pre-dialysis and dialysis patients, depending upon the individuals nutritional requirements and needs.
• Renastep can be used as an oral nutritional supplement when nutrition support is needed and a dietary potassium and / or phosphate restriction are needed.
• Renastep can be given as a drink or in small volume such as 30ml-40ml throughout the day as needed.
• Renastep has a mild vanilla flavour and so can be used in recipes or flavoured using suitable low potassium, low phosphate syrups.
• Renastep can be used alongside standard / compact style ONS to meet energy and protein requirements, whilst limiting potassium and phosphorus intake.