Assessment of nutritional status in children with chronic kidney disease and on dialysis

Abstract

Protein-energy wasting (PEW) is defined as a state of decreased body protein mass and fuel reserves (body protein and fat mass) and is a common complication of chronic kidney disease (CKD). It is multifactorial: the main causative factors are hormonal imbalances and a low nutrient intake, but low residual renal function, inadequate dialysis dose, chronic inflammation and metabolic acidosis are other important contributory factors. Adult PEW has been defined, but there is no accepted definition of pediatric PEW and consequently no precise diagnostic criteria. Assessing nutritional status in children is also complicated by the absence of a gold standard, specific abnormalities in body composition, and the slowly progressive course of the disease. The evaluation of PEW should take into account all of its pathogenetic aspects, which include dietary assessment, clinical and anthropometric assessment (based on weight, height, and body mass index), a panel of biochemical parameters, and a normalized protein catabolic rate (in the case of adolescents on hemodialysis). Bioimpedance indices can be used in individual patients on a regular basis in centers with expertise. The longitudinal follow-up data relating to the above parameters are valuable for comparing patient and normative data. Given the complex nature of PEW, only a multidisciplinary approach can provide an accurate assessment of nutritional status and its derangements in children with CKD and on dialysis.

Anthropometric and Biochemical Profile of Children and Adolescents with Chronic Kidney Disease in a Predialysis Pediatric Interdisciplinary Program

“…Nutritional care of these patients should be focused on maintaining adequate nutritional status, body mass index (BMI) Z score between −2 and +1, and height for age greater than or equal to −2 Z score [4, 8]. These goals should be achieved by providing a specific diet that also reduces the occurrence of uremic toxicity, metabolic abnormalities, and comorbidities related to CKD [4, 8, 9]. Conventional anthropometry remains to be the method most often used to monitor nutritional state in CKD patients [4, 8, 9].…”

“…These goals should be achieved by providing a specific diet that also reduces the occurrence of uremic toxicity, metabolic abnormalities, and comorbidities related to CKD [4, 8, 9]. Conventional anthropometry remains to be the method most often used to monitor nutritional state in CKD patients [4, 8, 9]. …”

Dietary sources of energy and nutrient intake among children and adolescents with chronic kidney disease

“…Malnutrition has been reported in children with CKD and can affect growth [2, 18]. Nutritional counseling and intervention is regarded as an effective method for optimizing growth and biochemical balance in children with CKD.…”

Cardiovascular risk factors and mortality in children with chronic kidney disease

“…[27,28] The finding of undernutrition in advanced CKD may be explained by low appetite, nausea and vomiting, and the effect of enforced dietary restriction resulting in caloric deficiency, along with chronic illness, an increased metabolic rate, metabolic acidosis and chronic inflammation, in a growing child. [29] Being overweight or obese has been reported to increase the risk of having other CVRFs (hypertension, dyslipidaemia and abnormal glucose metabolism) when compared with lean patients. [3] It should be emphasised at this point that the CKD I group did not have proteinuria, so it is unlikely that the presence of patients with nephrotic syndrome influenced the rate of hypercholesterolaemia in this group.…”