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Assessment of Protein Energy Wasting in Children With Chronic Kidney Disease: A Cross-Sectional Study
Mohammed Kaif K Mulla1, Bobbity Deepthi1, Madhileti Sravani1
1Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Insights
Protein energy wasting (PEW) affects many children with chronic kidney disease (CKD), with prevalence varying by definition. Nutritional assessment tailored to age is crucial, as PEW increases with CKD severity.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Chronic Kidney Disease Research
Background:
- Protein energy wasting (PEW) is a significant concern in pediatric chronic kidney disease (CKD), yet its prevalence and diagnostic criteria require further investigation.
- Limited studies have explored the prevalence of PEW in children across various stages of CKD (2-5D).
Purpose of the Study:
- To determine the prevalence of PEW in children aged 2-18 years with CKD stages 2-5D.
- To compare the prevalence of PEW using minimal, standard, and modified diagnostic criteria.
- To describe the clinical characteristics of children with PEW.
Main Methods:
- A cross-sectional study involving 150 children (aged 2-18 years) with CKD stages 2-5D was conducted.
- Demographic, clinical, biochemical, and growth parameters were collected.
- Three PEW definitions (minimal, standard, modified) were applied, and descriptive statistics were used for analysis.
Main Results:
- PEW prevalence varied from 13.3% (standard definition) to 46.7% (minimal definition).
- The prevalence of modified PEW increased with advancing CKD stage (P=.04).
- Reduced muscle mass was a consistent finding; infection-related hospitalization was higher in children with PEW (P=.008).
Conclusions:
- PEW prevalence in pediatric CKD is substantial and definition-dependent, ranging from 13.3% to 46.7%.
- PEW prevalence escalates with CKD stage, underscoring the need for vigilant monitoring.
- Age-appropriate criteria, including anthropometry, are essential for accurate nutritional assessment in pediatric CKD patients.
Objectives:
Limited studies exist on prevalence of Protein energy wasting (PEW) in children with chronic kidney disease. The study aimed to determine the prevalence of PEW in children aged 2-18 years with CKD stage 2-5D, compare various diagnostic criteria and describe clinical characteristics of children with PEW.
Methods:
A cross-sectional study (September 2023 to February 2024) conducted at the pediatric nephrology services of a tertiary-care center investigated children aged 2-18 years diagnosed with CKD stages 2-5D for PEW. Demographic, clinical, biochemical details and growth parameters were recorded at enrollment. The study employed three 3 PEW definitions: minimal, standard, and modified. Descriptive statistics were performed using STATA 14.0.
Results:
The study enrolled 150 children (79.4% boys) in CKD 2-5D with a median (interquartile range) age of 10.6 (7,13.1) years. Congenital anomalies of kidney and urinary tract were the most common etiology in 104 (69.4%) children. The median estimated glomerular filtration rate at enrollment was 23.2 (12.7, 40) mL/min/1.73 m2. Seventy (46.7%) children satisfied minimal PEW definition, 20 (13.3%) children met standard PEW definition, and 40 (27.3%) satisfied pediatric tailored modified PEW definition. There was an increasing prevalence of modified PEW with advancing CKD stage (P =.04). Among individual parameters contributing to diagnosis of PEW, reduced muscle mass was a consistent finding, while serum albumin, short stature, and reduced body mass varied with CKD severity (P < .05). Children with modified PEW were more likely to be severely wasted and/or severely underweight. Infection-related hospitalization rate was significantly higher in children with PEW (P = .008).
Conclusion:
The prevalence of PEW ranged from 13.3% to 46.7% depending on the definition used. Importantly, the prevalence increased with advancing stages of CKD. Age-appropriate criteria, like anthropometry, are crucial and highlight the need for tailored nutritional assessment in children.
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