Acceptability of a reformulated renal-specific micronutrient supplement
Sirs, There is no approved micronutrient supplement specifically formulated for children with chronic renal failure (CRF). Size, palatability, and format of any supplement may impact upon compliance with long-term treatment [1, 2]. We previously reported the use of a renal-specific micronutrient supplement (RSM) formulated by Vitaline Pharmaceuticals UK, which provided the recommended dietary reference intakes for vitamins B1, B2, B3, B5, B6, B12 as well as vitamins C, E, K, copper, zinc, and folic acid. The RSM was tested against our previous standard of Ketovite tablets and found to be preferable in terms of smell and taste but not size [3]. The results of the initial study encouraged us to reduce the size and shape of the RSM and produce it in a scored caplet form with half a caplet daily for children under 5 years of age and one caplet daily for children over 5 years. In addition, the folic acid was increased from 200 g to 1,000 g/caplet in an attempt to further reduce plasma homocysteine levels (Table 1) [4]. We recruited 25 children (16 male) from four regional paediatric nephrology units with a mean age of 11.6 years (range 1.8–17 years); 8 had CRF, 6 were on haemodialysis, and 11 on automated peritoneal dialysis. Patients had been on Ketovite tablets for a minimum of 3 months and the patient and/or parent completed a questionnaire before and after switching to the RSM for 2 weeks. Research ethics approval was obtained. There was a significant reduction (P<0.001) in the number of RSM caplets taken daily, with 92% of patients taking only one RSM caplet compared with 52% consuming three Ketovite tablets. The majority of patients swallowed the Ketovite or RSM whole, but the RSM did allow a number of children to chew the caplet (6 patients compared with 2 on Ketovite). There were 3 children that received the RSM either crushed or dissolved in water and administered via gastrostomy button or nasogastric tube. The results of the questionnaire showed that the smell and taste of the RSM was superior to that of Ketovite (P<0.001) with maintained ease of administration despite the larger caplet size of the RSM. Of the children, 60% favoured the RSM and a similar percentage wished to continue it after the study period. One child commented