Division of Pediatric Nephrology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, USA.
Pediatr Nephrol. 2024 Jan;39(1):243-250. doi: 10.1007/s00467-023-06078-7. Epub 2023 Jul 18.
Protein energy wasting (PEW), a state of deficient protein storage, is not well understood in children and adolescents with chronic kidney disease (CKD). We aimed to re-define PEW using pediatric malnutrition guidelines from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), and to describe the relationship between PEW, malnutrition, and kidney function.
This was a retrospective review of outpatients ≤ 20 years old with a diagnosis of CKD from January 1, 2013, to August 31, 2018. Malnutrition was diagnosed by a licensed dietitian, and PEW was diagnosed using an updated definition incorporating AND/ASPEN malnutrition guidelines. Logistic regression and linear mixed effects modeling were performed on the relationship of malnutrition and PEW to estimated glomerular filtration rate (eGFR).
The 142 patients included in this analysis had a median age of 11.1 years and median eGFR of 57 ml/min/1.73 m at initial visit. Malnutrition was diagnosed in 50% of patients in at least one visit, and 17.6% met ≥ 2 PEW criteria. Patients with eGFR < 30 ml/min/1.73 m had significantly increased risk of malnutrition [OR 2.5, 95% CI 2.0-3.3] (p < 0.001) and PEW [OR 4.9, 95% CI 3.0-8.0] (p < 0.001). A diagnosis of malnutrition or PEW was associated with worse eGFR by logistic regression (p = 0.01 and p = 0.001, respectively) and more rapid eGFR decline by linear mixed effects model (p = 0.002 and p < 0.001, respectively) compared to those without these diagnoses.
Malnutrition and PEW are prevalent in pediatric CKD and are associated with significantly lower eGFR and more rapid decline in eGFR, emphasizing the need to address nutritional status. A higher resolution version of the Graphical abstract is available as Supplementary information.
蛋白质能量消耗（PEW）是一种蛋白质储存不足的状态，在儿童和青少年慢性肾脏病（CKD）中尚未得到很好的理解。我们旨在使用营养与饮食学会/美国肠外与肠内营养学会（AND/ASPEN）的儿科营养不良指南重新定义 PEW，并描述 PEW、营养不良和肾功能之间的关系。
这是一项对 2013 年 1 月 1 日至 2018 年 8 月 31 日期间门诊就诊的≤20 岁患有 CKD 诊断的患者进行的回顾性研究。由注册营养师诊断营养不良，使用纳入 AND/ASPEN 营养不良指南的更新定义来诊断 PEW。对营养不良和 PEW 与估计肾小球滤过率（eGFR）的关系进行逻辑回归和线性混合效应模型分析。
本分析纳入的 142 例患者的中位年龄为 11.1 岁，初次就诊时的中位 eGFR 为 57ml/min/1.73m。在至少一次就诊中，50%的患者被诊断为营养不良，17.6%符合≥2 项 PEW 标准。eGFR<30ml/min/1.73m 的患者营养不良的风险显著增加[OR 2.5，95%CI 2.0-3.3]（p<0.001）和 PEW[OR 4.9，95%CI 3.0-8.0]（p<0.001）。逻辑回归显示，营养不良或 PEW 的诊断与 eGFR 更差相关（p=0.01 和 p=0.001），线性混合效应模型显示，eGFR 下降速度更快（p=0.002 和 p<0.001）与无这些诊断的患者相比。
营养不良和 PEW 在儿科 CKD 中很常见，与 eGFR 显著降低和 eGFR 下降速度加快显著相关，强调需要解决营养状况。可提供图形摘要的更高分辨率版本作为补充信息。
