Protein energy wasting in children with chronic kidney disease

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• 作者：Alison G. Abraham (1)
  Robert H. Mak (2)
  Mark Mitsnefes (3)
  Colin White (4)
  Marva Moxey-Mims (5)
  Bradley Warady (6)
  Susan L. Furth (7)
  
• 关键词：Cachexia inflammation syndrome ; Hospitalization ; Chronic kidney disease ; Malnutrition ; Growth ; Glomerular filtration rate
• 刊名：Pediatric Nephrology
• 出版年：2014
• 出版时间：July 2014
• 年：2014
• 卷：29
• 期：7
• 页码：1231-1238
• 全文大小：
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• 作者单位：Alison G. Abraham (1)
  Robert H. Mak (2)
  Mark Mitsnefes (3)
  Colin White (4)
  Marva Moxey-Mims (5)
  Bradley Warady (6)
  Susan L. Furth (7)
  
  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
  2. Department of Pediatrics, UC San Diego School of Medicine, San Diego, CA, USA
  3. Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH, USA
  4. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
  5. Division of Kidney, Urology and Hematology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
  6. Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
  7. Department of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
  
• ISSN：1432-198X

文摘

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 (? of the four criteria); (2) a standard PEW definition (? of the four criteria); (3) a modified PEW definition (? 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), 7-0?% 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--.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--.06). Conclusions The inclusion of a criterion based on growth may augment the definition of PEW and improve risk discrimination in children with CKD.