Collaborative role of muscle ultrasonography and subjective global-nutritional assessment in pediatric end-stage renal disease.

BACKGROUND

Nutritional well-being in childhood chronic kidney disease (CKD) represents a multidisciplinary problem. Nevertheless, reliable nutritional status assessment considering underlying pathogenesis remains challenging. So, we aimed to assess the collaborative role of quadriceps muscle ultrasonography and subjective global nutritional assessment (SGNA) in evaluating childhood end-stage renal disease on hemodialysis (ESRD-HD).

METHODS

Sixty-eight children with ESRD-HD were enrolled in addition to 68 age- and sex-matched healthy controls. All participants underwent nutritional screening through SGNA, 24-h dietary recall estimation, anthropometric measurements, evaluation of protein energy wasting (PEW), and quadriceps muscle ultrasonography.

RESULTS

SGNA identified malnourishment in 85.3% of ESRD-HD children, while reduced/low muscle mass (LMM) by ultrasound was estimated in 73.6%, compared to PEW documentation in 70.6% of them. Total caloric intake discriminates LMM at a cutoff level of ≤34.022 kcal/kg/day with 93.75% sensitivity and 85.0% specificity and revealed a significant association with both PEW and LMM on regression analysis. Concerning concordance with muscle ultrasonography, SGNA had statistically good agreement, unlike anthropometric parameters.

CONCLUSIONS

Inadequate dietary intake, though highly prevalent, is still underestimated in CKD children with a negative impact on muscle mass. Also, SGNA, through combining objective anthropometry with nutrition-focused assessment, could represent a potential role for nutritional status evaluation.

IMPACT: Despite the absence of single gold standard assessment tool, PEW remains a prevalent, multifactorial nutritional comorbidity in CKD children that necessitates continuous nutritional monitoring. Quadriceps muscle ultrasound can detect changes in body composition associated with CKD, that cannot be determined just by objective anthropometry. SGNA, a simple malnutrition screening tool, showed a potential role in early prediction of both physical growth and body composition abnormalities. Dietary management for children with ESRD-HD should pay attention to total caloric, carbohydrate, and fat intakes, not just protein intake, for actual growth and body composition support.