Protein energy wasting in children with chronic kidney disease

Alison Gump Abraham, Robert H. Mak, Mark Mitsnefes, Colin White, Marva Moxey-Mims, Bradley Warady, Susan L. Furth

Research output: Contribution to journalArticle

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 m2, 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.

Original languageEnglish (US)
Pages (from-to)1231-1238
Number of pages8
JournalPediatric Nephrology
Volume29
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Chronic Renal Insufficiency
Proteins
Hospitalization
Growth
Social Adjustment
Appetite
Glomerular Filtration Rate
African Americans
Pediatrics
Muscles
Incidence

Keywords

  • Cachexia inflammation syndrome
  • Chronic kidney disease
  • Glomerular filtration rate
  • Growth
  • Hospitalization
  • Malnutrition

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Abraham, A. G., Mak, R. H., Mitsnefes, M., White, C., Moxey-Mims, M., Warady, B., & Furth, S. L. (2014). Protein energy wasting in children with chronic kidney disease. Pediatric Nephrology, 29(7), 1231-1238. https://doi.org/10.1007/s00467-014-2768-9

Protein energy wasting in children with chronic kidney disease. / Abraham, Alison Gump; Mak, Robert H.; Mitsnefes, Mark; White, Colin; Moxey-Mims, Marva; Warady, Bradley; Furth, Susan L.

In: Pediatric Nephrology, Vol. 29, No. 7, 2014, p. 1231-1238.

Research output: Contribution to journalArticle

Abraham, AG, Mak, RH, Mitsnefes, M, White, C, Moxey-Mims, M, Warady, B & Furth, SL 2014, 'Protein energy wasting in children with chronic kidney disease', Pediatric Nephrology, vol. 29, no. 7, pp. 1231-1238. https://doi.org/10.1007/s00467-014-2768-9
Abraham, Alison Gump ; Mak, Robert H. ; Mitsnefes, Mark ; White, Colin ; Moxey-Mims, Marva ; Warady, Bradley ; Furth, Susan L. / Protein energy wasting in children with chronic kidney disease. In: Pediatric Nephrology. 2014 ; Vol. 29, No. 7. pp. 1231-1238.
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AB - 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 m2, 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.

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