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Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

Madhileti Sravani1, Sumitra Selvam2, Arpana Iyengar3

  • 1Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.

Pediatric Nephrology (Berlin, Germany)
|September 27, 2024
PubMed

Insights

Children with chronic kidney disease (CKD) experiencing protein energy wasting (PEW) or undernutrition face significantly higher rates of infection-related hospital admissions. These nutritional issues are key risk factors for severe infections in pediatric CKD patients.

Area of Science:

  • Pediatric Nephrology
  • Clinical Nutrition
  • Infectious Diseases

Background:

  • Protein energy wasting (PEW) and undernutrition are common in children with chronic kidney disease (CKD).
  • The clinical impact of these nutritional issues on outcomes, particularly infection-related hospital admissions (IRHA), is not well understood.
  • This study aimed to investigate the association between nutritional status and IRHA in pediatric CKD patients.

Purpose of the Study:

  • To assess the relationship between nutritional parameters and infection-related hospital admissions (IRHA) in children with chronic kidney disease (CKD).
  • To identify risk factors for IRHA and recurrent infections in this vulnerable pediatric population.

Main Methods:

  • A prospective longitudinal study involving 137 children (aged 2-18 years) with CKD stages 2-5D, free of infection for one month prior.
  • Nutritional status was evaluated using subjective global nutritional assessment for undernutrition and pediatric criteria for PEW, with modified PEW including short stature.
  • IRHA (severe viral, bacterial, or fungal infections) were recorded over a mean follow-up of 38 months.

Main Results:

  • 60% of children had undernutrition, and 52% had PEW.
  • The incidence rate of IRHA was significantly higher in children with undernutrition (1.74/patient-year) and PEW (1.74/patient-year) compared to their well-nourished counterparts.
  • Independent risk factors for IRHA included undernutrition, low BMI, hypoalbuminemia, dialysis status, modified PEW (OR 5.34), and elevated CRP (OR 4.66). Modified PEW and BMI were associated with a twofold risk of recurrent infections.

Conclusions:

  • Children with CKD2-5D and undernutrition or PEW have a significantly elevated incidence rate of IRHA.
  • Dialysis, poor nutritional status, and inflammation are identified as risk factors for IRHA.
  • Modified PEW and BMI are specifically linked to an increased risk of recurrent infections in this cohort.
Abstract

Keywords:
Chronic kidney disease (CKD)Infection related hospital admission (IRHA)Protein energy wasting (PEW)Subjective global nutrition assessment (SGNA)

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