Protein energy wasting in children with chronic kidney disease

Abstract

Background: In adults with chronic kidney disease (CKD), protein-energy wasting (PEW) is a risk factor for hospitalization and death. However, PEW in children with CKD is not well characterized or defined.

Methods: Using data from the Chronic Kidney Disease in Children study, we assessed three alternate definitions of PEW using biochemical parameters, body and muscle mass measurements, and reported appetite as described in adults: (1) a minimal PEW definition (≥2 of the four criteria); (2) a standard PEW definition (≥3 of the four criteria); (3) a modified PEW definition (≥3 of the four criteria plus a pediatric-focused criterion of short stature or poor growth).

Results: Of the 528 children analyzed in this study (median age 12 years, median glomerular filtration rate 45 mL/min/1.73 m(2), 39% female, 18% African American), 7-20% met the spectrum of definitions for PEW. The unadjusted incidence rates for incident hospitalizations were 1.9-, 2.1-, and 2.2-fold higher for those children diagnosed with PEW using the minimal, standard, and modified definitions, respectively (P = 0.08, 0.09 and 0.03). Following adjustment, only the modified PEW definition, which added short stature or poor growth as a criterion, showed modest significance (P = 0.06).

Conclusions: The inclusion of a criterion based on growth may augment the definition of PEW and improve risk discrimination in children with CKD.

Conflict of interest statement

Disclosure

No conflict of interest to disclose.

Figures

Figure 1

The prevalence of indicators of PEW used to form the three definitions. The prevalence is presented stratified by CKD stage (stage 1or 2, stage 3a, stage 3b and stage 4 or 5) and also overall.

Figure 2

The prevalence of PEW as classified using the three definitions: minimal PEW definition that required at least one test in ≥2 of the 4 original categories; a standard PEW definition that required at least one test in ≥3 of the 4 original categories; and a modified PEW definition that required at least one test in ≥3 of the 5 categories (4 original plus poor growth). The prevalence is presented stratified by CKD stage (stage 1or 2, stage 3a, stage 3b and stage 4 or 5) and also overall.

Figure 3

The unadjusted and adjusted incidence rate ratios for hospitalizations within the 2 years from baseline comparing the three PEW definitions.