Assessment of nutritional status in children with chronic kidney disease

The achievement of a normal nutritional status, that is a normal body composition and a normal pattern of growth, is a cornerstone in the management of children with chronic kidney disease (CKD). Protein-energy wasting (PEW) which indicates the state of decreased body protein mass and fuel reserves (body protein and fat mass), is a common condition in this population, and a source of morbidity and mortality. For the diagnosis of this condition, a lot of methods have been proposed, but due to the clinical characteristics of children with CKD, the intrinsic limits of the available indices and some methodological issues concerning published pediatric studies, none of these parameters could be considered as the gold standard. Given these limitations, a general consensus exists according to which only the combination of more indices integrated in a multidisciplinary approach can give the idea of the individual nutritional status. Among these indices, recent guidelines recommend dietary intake (by means of 3-day diary or 24-hour recall), anthropometric parameters (weight, height, height velocity, body mass index, head circumference) and, only for adolescent on hemodialysis, normalized protein catabolic rate as the most accurate ones. Other methods, such as mid-arm anthropometry, bioimpedance analysis, biochemical indices, and dual-energy X-ray absorptiometry could certainly help in the nutritional evaluation, taking into account the advantages and drawbacks of each method.