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- Title
Malnutrition and protein energy wasting are associated with severity and progression of pediatric chronic kidney disease.
- Authors
Shen, Carol L.; Liebstein, Dana; Fernandez, Hilda
- Abstract
Background: Protein energy wasting (PEW), a state of deficient protein storage, is not well understood in children and adolescents with chronic kidney disease (CKD). We aimed to re-define PEW using pediatric malnutrition guidelines from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), and to describe the relationship between PEW, malnutrition, and kidney function. Methods: This was a retrospective review of outpatients ≤ 20 years old with a diagnosis of CKD from January 1, 2013, to August 31, 2018. Malnutrition was diagnosed by a licensed dietitian, and PEW was diagnosed using an updated definition incorporating AND/ASPEN malnutrition guidelines. Logistic regression and linear mixed effects modeling were performed on the relationship of malnutrition and PEW to estimated glomerular filtration rate (eGFR). Results: The 142 patients included in this analysis had a median age of 11.1 years and median eGFR of 57 ml/min/1.73 m2 at initial visit. Malnutrition was diagnosed in 50% of patients in at least one visit, and 17.6% met ≥ 2 PEW criteria. Patients with eGFR < 30 ml/min/1.73 m2 had significantly increased risk of malnutrition [OR 2.5, 95% CI 2.0–3.3] (p < 0.001) and PEW [OR 4.9, 95% CI 3.0–8.0] (p < 0.001). A diagnosis of malnutrition or PEW was associated with worse eGFR by logistic regression (p = 0.01 and p = 0.001, respectively) and more rapid eGFR decline by linear mixed effects model (p = 0.002 and p < 0.001, respectively) compared to those without these diagnoses. Conclusions: Malnutrition and PEW are prevalent in pediatric CKD and are associated with significantly lower eGFR and more rapid decline in eGFR, emphasizing the need to address nutritional status.
- Subjects
CHRONIC kidney failure complications; DISEASE progression; GLOMERULAR filtration rate; KIDNEYS; CONFIDENCE intervals; PROTEIN-energy malnutrition; RETROSPECTIVE studies; REGRESSION analysis; SEVERITY of illness index; RISK assessment; COMPARATIVE studies; MALNUTRITION; DESCRIPTIVE statistics; LOGISTIC regression analysis; ODDS ratio; DISEASE risk factors; CHILDREN
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 1, p243
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-023-06078-7