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Malnutrition and protein energy wasting are associated with severity and progression of pediatric chronic kidney disease

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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.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Carol L. Shen

  2. Department of Pediatrics, New York Presbyterian Morgan Stanley Children‘s Hospital of New York, New York, USA

    Dana Liebstein

  3. Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA

    Hilda Fernandez

Authors
  1. Carol L. Shen
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  2. Dana Liebstein
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  3. Hilda Fernandez
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Carol Shen and Dana Liebstein. Nutritional assessments were made by Dana Liebstein. Statistical analyses were performed by Carol Shen and Hilda Fernandez. Drafts and edits of the manuscript were written by all authors. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Carol L. Shen.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Columbia University approved this study.

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The authors declare no competing interests.

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Shen, C.L., Liebstein, D. & Fernandez, H. Malnutrition and protein energy wasting are associated with severity and progression of pediatric chronic kidney disease. Pediatr Nephrol 39, 243–250 (2024). https://doi.org/10.1007/s00467-023-06078-7

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  • DOI: https://doi.org/10.1007/s00467-023-06078-7

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