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A Way to Diagnose Protein Energy Wasting in Children with Kidney Disease

CHILDREN with kidney disease are vulnerable to protein energy wasting (PEW), reported an observational study from St John’s National Academy of Health Sciences, Bangalore, India. PEW is a maladaptive metabolic state, where the body experiences decreased stores of protein and energy fuels. The condition is well defined in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) and is associated with an increased morbidity and mortality in these patients. However, PEW is under-recognised in children with CKD and ESKD; on the finding that the condition was prevalent in this patient population and arguing that there was a scarcity of research in PEW in children with CKD or ESKD, the research group set out to determine the burden and factors associated with the condition and assess the criteria currently used to diagnose PEW in children. 

The team recruited 123 participants: a male-to-female ratio of 3:1, 73 with CKD Stage 2–4, and 50 with ESKDPEW was assessed based on height for age, BMI for height, mid-upper arm circumference, cholesterol, serum albumin, transferrin, C-reactive protein, and appetite. PEW was observed in 58% of the total study cohort (47% in the group with CKD Stage 2–4; 73% in the group with ESKD). Of the children with ESKD, PEW was observed to be present in all on haemodialysis and 74% on peritoneal dialysis.  

Anthropometric measures (e.g., reduced BMI and muscle mass) and appetite were found to be the most accurate measures to diagnose PEW in childrenand the researchers noted that the role of biochemical measures (e.g., serum albumin and cholesterol) was very limited. The findings suggest that a combination of reduced appetite, mid-upper arm circumference, short stature, and high C-reactive protein should be used to diagnose PEW in children.  

“Children with CKD and those on dialysis are vulnerable to PEW,” the researchers concluded. “There has been no clear consensus on the approach to diagnosing paediatric PEW in clinical practice compared to adults. The observations from this study reveal that exclusive criteria may be needed to diagnose PEW in children with CKD and ESKD based on three factors: anthropometry, appetite, and inflammation.”