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Perceived appetite and clinical outcomes in children with chronic kidney disease

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Abstract

Background

Children with chronic kidney disease (CKD) may have impaired caloric intake through a variety of mechanisms, with decreased appetite as a putative contributor. In adult CKD, decreased appetite has been associated with poor clinical outcomes. There is limited information about this relationship in pediatric CKD.

Methods

A total of 879 participants of the Chronic Kidney Disease in Children (CKiD) study were studied. Self-reported appetite was assessed annually and categorized as very good, good, fair, or poor/very poor. The relationship between appetite and iohexol or estimated glomerular filtration rate (ieGFR), annual changes in anthropometrics z-scores, hospitalizations, emergency room visits, and quality of life were assessed.

Results

An ieGFR < 30 ml/min per 1.73 m2 was associated with a 4.46 greater odds (95 % confidence interval: 2.80, 7.09) of having a worse appetite than those with ieGFR >90. Appetite did not predict changes in height, weight, or BMI z-scores. Patients not reporting a very good appetite had more hospitalizations over the next year than those with a very good appetite. Worse appetite was significantly associated with lower parental and patient reported quality of life.

Conclusions

Self-reported appetite in children with CKD worsens with lower ieGFR and is correlated with clinical outcomes, including hospitalizations and quality of life.

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid. Research at Emory University supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Emory University, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA

    Frank W. Ayestaran

  2. Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Frank W. Ayestaran & Larry A. Greenbaum

  3. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Michael F. Schneider

  4. Albert Einstein School of Medicine, New York, NY, USA

    Frederick J. Kaskel

  5. Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Poyyapakkam R. Srivaths

  6. Pediatric Specialists of Virginia and Georgetown University Hospital, Fairfax, VA, USA

    Patricia W. Seo-Mayer

  7. National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Marva Moxey-Mims

  8. Children’s Hospital Pennsylvania, Philadelphia, PA, USA

    Susan L. Furth

  9. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Susan L. Furth

  10. Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley A. Warady

Authors
  1. Frank W. Ayestaran
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  2. Michael F. Schneider
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  3. Frederick J. Kaskel
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  4. Poyyapakkam R. Srivaths
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  5. Patricia W. Seo-Mayer
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  6. Marva Moxey-Mims
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  7. Susan L. Furth
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  8. Bradley A. Warady
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  9. Larry A. Greenbaum
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Corresponding author

Correspondence to Frank W. Ayestaran.

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Ethical statement

The study design and conduct were approved by an external study monitoring board appointed by the National Institute of Diabetes and Digestive and Kidney Diseases and by the institutional review boards of each participating center.

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Ayestaran, F.W., Schneider, M.F., Kaskel, F.J. et al. Perceived appetite and clinical outcomes in children with chronic kidney disease. Pediatr Nephrol 31, 1121–1127 (2016). https://doi.org/10.1007/s00467-016-3321-9

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  • DOI: https://doi.org/10.1007/s00467-016-3321-9

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