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Corsello A, Trovato CM, Dipasquale V, Proverbio E, Milani GP, Diamanti A, Agostoni C, Romano C. Malnutrition management in children with chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06436-z. [PMID: 38954039 DOI: 10.1007/s00467-024-06436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
Chronic kidney disease (CKD) encompasses diverse conditions such as congenital anomalies, glomerulonephritis, and hereditary nephropathies, necessitating individualized nutritional interventions. Early detection is pivotal due to the heightened risk of adverse outcomes, including compromised growth and increased healthcare costs. The nutritional assessment in pediatric CKD employs a comprehensive, multidisciplinary approach, considering disease-specific factors, growth metrics, and dietary habits. The prevalence of malnutrition, as identified through diverse tools and guidelines, underscores the necessity for regular and vigilant monitoring. Nutritional management strategies seek equilibrium in calorie intake, protein requirements, and electrolyte considerations. Maintaining a well-balanced nutritional intake is crucial for preventing systemic complications and preserving the remaining kidney function. The nuanced landscape of enteral nutrition, inclusive of gastrostomy placement, warrants consideration in scenarios requiring prolonged support, with an emphasis on minimizing risks for optimized outcomes. In conclusion, the ongoing challenge of managing nutrition in pediatric CKD necessitates continuous assessment and adaptation. This review underscores the significance of tailored dietary approaches, not only to foster growth and prevent complications but also to enhance the overall quality of life for children grappling with CKD.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Emanuele Proverbio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
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2
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Ardissino G, Matta R, Patricelli M, Capone V, Leoni A, Groppelli A, Vettoretti S, Pavone L, Margiotta E, Brancadoro A, Grimaldi E, Cropanese I, Raffiotta F, Messa P, Montini G. Calcium carbonate-enriched cheese to improve nutrition, compliance and phosphorus control in patients on kidney replacement therapy. J Nephrol 2021; 35:305-309. [PMID: 34185278 PMCID: PMC8240068 DOI: 10.1007/s40620-021-01102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
Background Patients on renal replacement therapy face many dietary limitations, and cheese is often limited because of its high phosphate content; we have developed cheese with added calcium carbonate (CaCO3) to provide patients with a nutritional opportunity while improving their phosphate control. Methods The present double-blind crossover study was aimed to compare the new modified cheese with an equivalent standard product in 16 patients. The increase in inter-dialysis phosphorus (ΔP) and pre-dialysis calcium were used as the primary endpoints for efficacy and safety. Results The median ΔP (and IQR) was significantly lower with the modified cheese compared with the standard product: 2.5 (1.9–2.9) mg/dL vs. 2.7 (2.2–3.4) mg/dL, respectively (p < 0.02). No difference was observed in pre-dialysis serum calcium levels. Conclusions The described modified cheese may represent an interesting means of overcoming some of the dietary limitations in patients on dialysis to help them achieve better nutrition and quality of life. Graphic abstract ![]()
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Affiliation(s)
- Gianluigi Ardissino
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Roberto Matta
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mariagrazia Patricelli
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Antonio Leoni
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Simone Vettoretti
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Pavone
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisabetta Margiotta
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Annamaria Brancadoro
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Emanuele Grimaldi
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Isabella Cropanese
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesca Raffiotta
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Piergiorgio Messa
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Abstract
Growth hormone (GH) has become a critical therapy for treating growth delay and failure in pediatric chronic kidney disease. Recombinant human GH treatment is safe and significantly improves height and height velocity in these growing patients and improved growth outcomes are associated with decreased morbidity and mortality as well as improved quality of life. However, the utility of recombinant human GH in adults with chronic kidney disease and end-stage renal disease for optimization of body habitus and reducing frailty remains uncertain. Semin Nephrol 41:x-xx © 2021 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Eduardo A Oliveira
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA; Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Caitlin E Carter
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA.
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4
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Catch-up growth in children with chronic kidney disease started on enteral feeding after 2 years of age. Pediatr Nephrol 2020; 35:113-118. [PMID: 31646404 PMCID: PMC6901400 DOI: 10.1007/s00467-019-04382-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/27/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Enteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age. METHODS Retrospective study of pre-transplant, pre-pubertal children (< 11 years) with CKD stages 2-5 started on nasogastric tube or gastrostomy feeds for the first time after age 2 years. Children were identified by searching dietetic records and the renal database. Children on growth hormone were excluded. Height, weight, and BMI were documented 1 year prior to and at the start of tube feeds, and after 1 and 2 years. Data collection ceased at transplantation. RESULTS Fifty children (25 male) were included. The median (range) age at start of tube feeds was 5.6 (2.1-10.9) years. Sixteen children were dialysed (1 haemodialysis, 15 peritoneal dialysis); 34 predialysis patients had a median (range) eGFR of 22 (6-88) ml/min/1.73 m2. Overall height SDS (Ht SDS) improved from - 2.39 to - 2.27 at 1 year and - 2.18 after 2 years (p = 0.02). BMI SDS improved from - 0.72 to 0.23 after 1 year and was 0.09 after 2 years of enteral feeding (p < 0.0001). Height SDS improved more in children aged 2-6 years (- 2.13 to - 1.68, p = 0.03) and in children not on dialysis (- 2.33 to - 1.99, p = 0.002). CONCLUSIONS Enteral tube feeding commenced after 2 years of age in prepubertal children with CKD improves height and weight SDS, with stability of BMI during the second year. Younger children and those not on dialysis had the greatest benefit.
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Abd El-Monem AM. Impact of chronic kidney disease on anthropometric profile, health-related quality of life and cognitive function in children. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_15_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Nelms CL. Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD). Front Pediatr 2018; 6:214. [PMID: 30116725 PMCID: PMC6083216 DOI: 10.3389/fped.2018.00214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
Growth in pediatric Chronic Kidney Disease is important for long-term outcomes including final adult height and cognitive function. However, there are many barriers for children with chronic kidney disease to achieve adequate nutritional intake to optimize growth. This review highlights these unique concerns, including route of nutrition, dialysis contributions and biochemical indices. Fitting the enteral feeding to the patients' needs involves choosing an appropriate product or products, limiting harmful nutrients in excess, notably aluminum, and altering for electrolyte and micronutrient needs. Unique adjustments to the enteral regimen include accommodating volume needs, optimizing macronutrient ratios, specific electrolyte adjustments, the blending of products together, and adjustments made to consider patient and family psychosocial needs. When a holistic approach to medical nutrition therapy is applied, taking the above factors into consideration, adequate intake for growth of the child with CKD is achievable.
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Affiliation(s)
- Christina L. Nelms
- PedsFeeds, Kearney, NE, United States
- Department of Family Studies, University of Nebraska System, Kearney, NE, United States
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7
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Muscle wasting in chronic kidney disease. Pediatr Nephrol 2018; 33:789-798. [PMID: 28508131 DOI: 10.1007/s00467-017-3684-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
Loss of lean body mass is a relevant component of the cachexia, or protein energy wasting (PEW), syndrome. Reduced muscle mass seems to be the most solid criterion for the presence of cachexia/PEW in patients with chronic kidney disease (CKD), and those with greater muscle mass loss have a higher risk of death. Children with CKD have many risk factors for lean mass and muscle wasting, including poor appetite, inflammation, growth hormone resistance, and metabolic acidosis. Mortality risks in patients with CKD increases as body mass index (BMI) and weight decreases. However, data regarding cachexia/PEW and muscle wasting in children with CKD is scarce due to lack of consensus in diagnostic criteria and an appropriate investigative methodology. Further research is urgently needed to address this important complication in the pediatric CKD setting, which may have fundamental impact on clinical outcomes.
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8
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Cachexia in children with chronic kidney disease: challenges in diagnosis and treatment. Curr Opin Support Palliat Care 2018; 10:293-297. [PMID: 27258684 DOI: 10.1097/spc.0000000000000217] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Although cachexia is highly prevalent in adult patients with chronic kidney disease (CKD), it is understudied and less well characterized in children. Recent evidence suggests that cachexia is also prevalent in children with CKD but presents challenges in diagnosis and treatment. RECENT FINDINGS A study from the CKD in children cohort showed that CKD cachexia or protein-energy wasting, using modified pediatric diagnostic criteria, such as lack of expected weight gain instead of weight loss and BMI for height age, had a prevalence of 7-20%. When growth indices such as height SD score (SDS)/height velocity SDS was included in the criteria, cachexia or PEW correlated with the morbidity outcome of increased hospitalization risk in children with CKD. Conversely, aggressive nutritional supplementation in children with advanced CKD, with nasogastric or gastric tube feeding, led to prevalence of obesity over that of cachexia. Body habitus of underweight and obesity have been shown to be associated with the worst clinical outcomes in both adults and children with CKD. SUMMARY Optimal nutritional therapy remains the mainstay of treatment of cachexia in CKD children with therapeutic goals of maintaining BMI as well as linear growth within the normal range.
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Silverstein DM. Growth and Nutrition in Pediatric Chronic Kidney Disease. Front Pediatr 2018; 6:205. [PMID: 30155452 PMCID: PMC6103270 DOI: 10.3389/fped.2018.00205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/28/2018] [Indexed: 12/14/2022] Open
Abstract
Children with chronic kidney disease (CKD) feature significant challenges to the maintenance of adequate nutrition and linear growth. Moreover, the impaired nutritional state contributes directly to poor growth. Therefore, it is necessary to consider nutritional status in the assessment of etiology and treatment of sub-optimal linear growth. The major causes of poor linear growth including dysregulation of the growth hormone/insulin-like growth factor-I (IGF-I) axis, nutritional deficiency, metabolic acidosis, anemia, renal osteodystrophy/bone mineral disease, and inflammation. This review summarizes the causes and assessment tools of growth and nutrition while providing a summary of state of the art therapies for these co-morbidities of pediatric CKD.
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Affiliation(s)
- Douglas M Silverstein
- Division of Reproductive, Gastrorenal, and Urology Devices, Office of Device Evaluation, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States
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10
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Abstract
Children with end-stage renal disease (ESRD) on hemodialysis are at increased risk for malnutrition. Aggressive nutrition intervention such as intradialytic parenteral nutrition (IDPN) should be considered to prevent further co-morbidities and mortality associated with malnutrition when other interventions fail. IDPN is a non-invasive method of providing nutrition to malnourished hemodialysis (HD) patients via the HD access throughout the HD treatment. Although the evidence on the long-term benefits of IDPN is scant in pediatrics, there is evidence that it improves metabolic parameters and nutritional status. In this paper, therapy with IDPN including indications, goals of therapy, and elements to monitor will be described. In addition, a practice guideline for prescribing IDPN is provided.
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11
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Ayestaran FW, Schneider MF, Kaskel FJ, Srivaths PR, Seo-Mayer PW, Moxey-Mims M, Furth SL, Warady BA, Greenbaum LA. Perceived appetite and clinical outcomes in children with chronic kidney disease. Pediatr Nephrol 2016; 31:1121-7. [PMID: 26857711 PMCID: PMC5627603 DOI: 10.1007/s00467-016-3321-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 12/22/2022]
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 m(2) 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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Affiliation(s)
| | | | | | | | | | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive Kidney Disease, National Institutes of Health, Bethesda, MD
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12
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Nguyen L, Levitt R, Mak RH. Practical Nutrition Management of Children with Chronic Kidney Disease. ACTA ACUST UNITED AC 2016. [DOI: 10.4137/cmu.s13180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic kidney disease (CKD) introduces a unique set of nutritional challenges for the growing and developing child. This article addresses initial evaluation and ongoing assessment of a child with CKD. It aims to provide an overview of nutritional challenges unique to a pediatric patient with CKD and practical management guidelines. Caloric assessment in children with CKD is critical as many factors contribute to poor caloric intake. Tube feeding is a practical option to provide the required calories and fluid in children who have difficulty with adequate oral intake. Protein intake should not be limited and should be further adjusted for protein loss with dialysis. Supplementation or restriction of sodium is patient specific. Urine output, fluid status, and modality of dialysis are factors that influence sodium balance. Hyperkalemia poses a significant cardiac risk, and potassium is closely monitored. In addition to a low potassium diet, potassium binders may be prescribed to reduce potassium load from oral intake. Phosphorus and calcium play a significant role in cardiovascular and bone health. Phosphorus binders have helped children and families manage phosphorus levels in conjunction with a phosphorus-restricted diet. Nutritional management of children with CKD is a challenge that requires continuous reassessment and readjustment as the child ages, CKD progresses, and urine output decreases.
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Affiliation(s)
- Lieuko Nguyen
- Division of Nephrology, Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Rayna Levitt
- Division of Nephrology, Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Robert H. Mak
- Division of Nephrology, Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
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Master Sankar Raj V, Garcia J, Gordillo R. 17-Year-Old Boy with Renal Failure and the Highest Reported Creatinine in Pediatric Literature. Case Rep Pediatr 2015; 2015:703960. [PMID: 26199780 PMCID: PMC4496647 DOI: 10.1155/2015/703960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/01/2015] [Indexed: 11/25/2022] Open
Abstract
The prevalence of chronic kidney disease (CKD) is on the rise and constitutes a major health burden across the world. Clinical presentations in early CKD are usually subtle. Awareness of the risk factors for CKD is important for early diagnosis and treatment to slow the progression of disease. We present a case report of a 17-year-old African American male who presented in a life threatening hypertensive emergency with renal failure and the highest reported serum creatinine in a pediatric patient. A brief discussion on CKD criteria, complications, and potential red flags for screening strategies is provided.
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Affiliation(s)
- Vimal Master Sankar Raj
- Department of Pediatric Nephrology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, IL 61603, USA
| | - Jessica Garcia
- Department of Pediatrics, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, IL 61603, USA
| | - Roberto Gordillo
- Department of Pediatric Nephrology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, IL 61603, USA
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14
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Ku E, Glidden DV, Hsu CY, Portale AA, Grimes B, Johansen KL. Association of Body Mass Index with Patient-Centered Outcomes in Children with ESRD. J Am Soc Nephrol 2015; 27:551-8. [PMID: 26054540 DOI: 10.1681/asn.2015010008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/24/2015] [Indexed: 12/17/2022] Open
Abstract
Obesity is associated with less access to transplantation among adults with ESRD. To examine the association between body mass index at ESRD onset and survival and transplantation in children, we performed a retrospective analysis of children ages 2-19 years old beginning RRT from 1995 to 2011 using the US Renal Data System. Among 13,172 children, prevalence of obesity increased from 14% to 18%, whereas prevalence of underweight decreased from 12% to 9% during this period. Over a median follow-up of 7.0 years, 10,004 children had at least one kidney transplant, and 1675 deaths occurred. Risk of death was higher in obese (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.03 to 1.32) and underweight (HR, 1.26; 95% CI, 1.09 to 1.47) children than children with normal body mass indices. Obese and underweight children were less likely to receive a kidney transplant (HR, 0.92; 95% CI, 0.87 to 0.97; HR, 0.83; 95% CI, 0.78 to 0.89, respectively). Obese children had lower odds of receiving a living donor transplant (odds ratio, 0.85; 95% CI, 0.74 to 0.98) if the transplant occurred within 18 months of ESRD onset. Adjustment for transplant in a time-dependent Cox model attenuated the higher risk of death in obese but not underweight children (HR, 1.09; 95% CI, 0.96 to 1.24). Lower rates of kidney transplantation may, therefore, mediate the higher risk of death in obese children with ESRD. The increasing prevalence of obesity among children starting RRT may impede kidney transplantation, especially from living donors.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, and
| | - David V Glidden
- Department of Biostatistics and Epidemiology, University of California, San Francisco, California
| | | | | | - Barbara Grimes
- Department of Biostatistics and Epidemiology, University of California, San Francisco, California
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15
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Silva VR, Soares CB, Magalhães JO, de Barcelos IP, Cerqueira DC, Simões e Silva AC, Oliveira EA. Anthropometric and biochemical profile of children and adolescents with chronic kidney disease in a predialysis pediatric interdisciplinary program. ScientificWorldJournal 2015; 2015:810758. [PMID: 25629088 PMCID: PMC4300020 DOI: 10.1155/2015/810758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/08/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022] Open
Abstract
This is longitudinal retrospective observational cohort study that evaluated anthropometric and biochemical variables of children and adolescents admitted to a Predialysis Interdisciplinary Management Program (PDIMP) responsible for the follow-up of children and adolescents at stages 2 to 4 of chronic kidney disease (CKD) at a tertiary center. One hundred thirty-eight patients with CKD on predialysis treatment with median age at admission of 9 years and the median follow-up time of 5 years were evaluated. Seventy-four (53%) had CKD stage 3 at admission and 70 (51%) reached CKD stage 5 at the end of the follow-up. There was no significant difference between the mean initial and final hemoglobin and serum albumin. However, the final serum bicarbonate presented a significant improvement. Analyses stratified according to clinical variables of interest showed a significant improvement in body mass index (BMI) Z score, especially in the subgroup of children admitted under two years of age. In relation to stature-for-age Z score, data show a significant improvement in stature SD at the end of the study. In conclusion, the present study showed improvement of nutritional status of CKD patients and that the deterioration of renal function was not correlated with BMI-for-age Z score.
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Affiliation(s)
- Vanessa R. Silva
- Nutrition Division, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), 30130-100 Belo Horizonte, MG, Brazil
| | - Cristina B. Soares
- Pediatric Nephrourology Unit, Department of Pediatrics, UFMG, 31270-901 Belo Horizonte, MG, Brazil
| | - Juliana O. Magalhães
- Nutrition Division, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), 30130-100 Belo Horizonte, MG, Brazil
| | | | - Debora C. Cerqueira
- Pediatric Nephrourology Unit, Department of Pediatrics, UFMG, 31270-901 Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões e Silva
- Pediatric Nephrourology Unit, Department of Pediatrics, UFMG, 31270-901 Belo Horizonte, MG, Brazil
- Pediatric Branch, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Alfredo Balena Avenue 190, 2nd Floor, Room No. 281, 30130-100 Belo Horizonte, MG, Brazil
| | - Eduardo A. Oliveira
- Pediatric Nephrourology Unit, Department of Pediatrics, UFMG, 31270-901 Belo Horizonte, MG, Brazil
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16
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Affiliation(s)
- Susan F Massengill
- Director, Pediatric Nephrology, Levine Children's Hospital, Adjunct Associate Professor of Pediatrics, University of North Carolina School of Medicine, Charlotte, NC
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17
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Bonthuis M, van Stralen KJ, Verrina E, Groothoff JW, Alonso Melgar Á, Edefonti A, Fischbach M, Mendes P, Molchanova EA, Paripović D, Peco-Antic A, Printza N, Rees L, Rubik J, Stefanidis CJ, Sinha MD, Zagożdżon I, Jager KJ, Schaefer F. Underweight, overweight and obesity in paediatric dialysis and renal transplant patients. Nephrol Dial Transplant 2013; 28 Suppl 4:iv195-iv204. [PMID: 23975752 DOI: 10.1093/ndt/gft259] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The prevalence of childhood overweight is rising worldwide, but in children on renal replacement therapy (RRT) a poor nutritional status is still the primary concern. We aimed to study the prevalence of, and factors associated with, underweight and overweight/obesity in the European paediatric RRT population. Moreover, we assessed the evolution of body mass index (BMI) after the start of RRT. METHODS We included 4474 patients younger than 16 years from 25 countries of whom BMI data, obtained between 1995 and 2010, were available within the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Prevalence estimates for under- and overweight/obesity were calculated using age and sex-specific criteria of the World Health Organization (WHO, 0-1 year olds) and the International Obesity Task Force cut-offs (2-15 year olds). RESULTS The prevalence of underweight was 3.5%, whereas 20.8% of the patients were overweight and 12.5% obese. Factors associated with being underweight were receiving dialysis treatment and infant age. Among transplanted recipients, a very short stature (OR: 1.64, 95% CI: 1.40-1.92) and glucocorticoid treatment (OR: 1.23, 95% CI: 1.03-1.47) were associated with a higher risk of being overweight/obese. BMI increased post-transplant, and a lower BMI and a higher age at the start of RRT were associated with greater BMI changes during RRT treatment. CONCLUSIONS Overweight and obesity, rather than underweight, are highly prevalent in European children on RRT. Short stature among graft recipients had a strong association with overweight, while underweight appears to be only a problem in infants. Our findings suggest that nutritional management in children receiving RRT should focus as much on the prevention and treatment of overweight as on preventing malnutrition.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rees L, Jones H. Nutritional management and growth in children with chronic kidney disease. Pediatr Nephrol 2013; 28:527-36. [PMID: 22825360 DOI: 10.1007/s00467-012-2258-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/18/2012] [Accepted: 06/09/2012] [Indexed: 01/06/2023]
Abstract
Despite continuing improvements in our understanding of the causes of poor growth in chronic kidney disease, many unanswered questions remain: why do some patients maintain a good appetite whereas others have profound anorexia at a similar level of renal function? Why do some, but not all, patients respond to increased nutritional intake? Is feed delivery by gastrostomy superior to oral and nasogastric routes? Do children who are no longer in the 'infancy' stage of growth benefit from enteral feeding? Do patients with protein energy wasting benefit from increased nutritional input? How do we prevent obesity, which is becoming so prevalent in the developed world? This review will address these issues.
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Affiliation(s)
- Lesley Rees
- Department of Nephrology, Gt Ormond St Hospital for Children Foundation Trust, Gt Ormond St, London, WC1N 3JH, UK.
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