Protein energy wasting in children with chronic kidney disease

Area of Science:

• Pediatric Nephrology
• Clinical Nutrition
• Chronic Kidney Disease Research

Background:

• Protein-energy wasting (PEW) is a known risk factor for adverse outcomes in adults with chronic kidney disease (CKD).
• PEW is not well-defined or characterized in pediatric populations with CKD.
• Accurate assessment of PEW is crucial for managing children with CKD.

Purpose of the Study:

• To evaluate and compare three distinct definitions of PEW in children with CKD.
• To determine the association between different PEW definitions and hospitalization risk.
• To assess the utility of incorporating growth parameters into PEW definitions for pediatric CKD.

Main Methods:

• Utilized data from the Chronic Kidney Disease in Children study.
• Assessed three PEW definitions: minimal (≥2 criteria), standard (≥3 criteria), and modified (≥3 criteria + growth criterion).
• Analyzed biochemical markers, body/muscle mass, appetite, and growth parameters in 528 children.

Main Results:

• 7-20% of children met the criteria for PEW across the evaluated definitions.
• Unadjusted hospitalization rates were higher in children with PEW (1.9-2.2 fold increase).
• The modified PEW definition, including growth, showed modest significance for predicting hospitalization risk (P=0.06).

Conclusions:

• The definition of PEW in children with CKD may benefit from including growth criteria.
• Incorporating growth parameters can potentially enhance risk stratification for hospitalization in pediatric CKD.
• Further research is warranted to refine PEW definitions in pediatric CKD.