Assessment of Protein Energy Wasting in Children With Chronic Kidney Disease: A Cross-Sectional Study.

OBJECTIVES

Limited studies exist on prevalence of Protein energy wasting (PEW) in children with chronic kidney disease. The study aimed to determine the prevalence of PEW in children aged 2-18 years with CKD stage 2-5D, compare various diagnostic criteria and describe clinical characteristics of children with PEW.

METHODS

A cross-sectional study (September 2023 to February 2024) conducted at the pediatric nephrology services of a tertiary-care center investigated children aged 2-18 years diagnosed with CKD stages 2-5D for PEW. Demographic, clinical, biochemical details and growth parameters were recorded at enrollment. The study employed three 3 PEW definitions: minimal, standard, and modified. Descriptive statistics were performed using STATA 14.0.

RESULTS

The study enrolled 150 children (79.4% boys) in CKD 2-5D with a median (interquartile range) age of 10.6 (7,13.1) years. Congenital anomalies of kidney and urinary tract were the most common etiology in 104 (69.4%) children. The median estimated glomerular filtration rate at enrollment was 23.2 (12.7, 40) mL/min/1.73 m2. Seventy (46.7%) children satisfied minimal PEW definition, 20 (13.3%) children met standard PEW definition, and 40 (27.3%) satisfied pediatric tailored modified PEW definition. There was an increasing prevalence of modified PEW with advancing CKD stage (P =.04). Among individual parameters contributing to diagnosis of PEW, reduced muscle mass was a consistent finding, while serum albumin, short stature, and reduced body mass varied with CKD severity (P < .05). Children with modified PEW were more likely to be severely wasted and/or severely underweight. Infection-related hospitalization rate was significantly higher in children with PEW (P = .008).

CONCLUSION

The prevalence of PEW ranged from 13.3% to 46.7% depending on the definition used. Importantly, the prevalence increased with advancing stages of CKD. Age-appropriate criteria, like anthropometry, are crucial and highlight the need for tailored nutritional assessment in children.