Liang Y, Jiang Y P, Wang H, Zhou N, Fu Q, Shen Y
Department 2 of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, Key Laboratory of Major Diseases in Children, National Center for Children's Health, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2023 Sep 2;61(9):794-798. doi: 10.3760/cma.j.cn112140-20230502-00309.
To analyze the clinical characteristics and risk factors of protein energy wasting (PEW) in children with chronic kidney disease (CKD). Clinical data of 231 children with chronic kidney disease hospitalized in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to January 2023 were retrospectively analyzed to explore the incidence of PEW. According to the diagnostic criteria of CKDPEW, they were divided into a CKDPEW group and a non PEW group. The comparison between the groups was performed by independent-sample test and Chi-squared test, and the risk factors were analyzed by multivariate Logistic regression. Among the 231 children, there were 138 males and 93 females, with a visiting age of 9.9 (7.9, 16.0) years; 6 cases were in stage 1, 14 cases in stage 2, 51 cases in stage 3, 36 cases in stage 4, and 124 cases in stage 5. A total of 30 children (13.0%) with CKD PEW were diagnosed at the age of 7. 1 (3.8, 13.2) years, including 1 case in stage 1, 1 case in stage 2, 5 cases in stage 3, 5 cases in stage 4, and 18 cases in stage 5. There were a total of 201 cases (87.0%) in the non PEW group, diagnosed at the age of 11.8 (8.5, 12.2) years, including 5 cases in stage 1, 13 cases in stage 2, 46 cases in stage 3, 31 cases in stage 4, and 106 cases in stage 5. The Chi-squared test and test showed that the systolic blood pressure, diastolic blood pressure, birth weight and carbon dioxide binding capacity of the CKD PEW group were lower than those of the non PEW group ((109±22) (120±20) mmHg (1 mmHg=0.133 kPa), (72±19) (79±16) mmHg, (2.9±0.5) (3.2±0.6) kg, (17±4) (19±4) mmol/L,=2.85, 2.14, 0.67, 2.63, all 0.05). Multivariate logistic regression analysis showed that carbon dioxide binding capacity and birth weight were independent protective factors of CKDPEW in children (=0.81 and 0.36, 95%=0.73-0.90 and 0.17-0.77, respectively; both 0.01); the risk of PEW in CKD children decreased by 0.187 times for every 1 mmol/L increment in carbon dioxide binding capacity, and 0.638 times for every 1 kg increment in birth weight. The incidence of protein energy expenditure in children with chronic kidney disease is lower than that in the previous researches. PEW can appear in CKD 1-2 stage, and attention should be paid to it in the early stage of CKD in clinical practice. Low birth weight CKD children are susceptible to PEW, and actively correcting metabolic acidosis can reduce the risk of CKDPEW.
分析慢性肾脏病（CKD）患儿蛋白质能量消耗（PEW）的临床特征及危险因素。回顾性分析2018年1月至2023年1月在首都医科大学附属北京儿童医院住院的231例慢性肾脏病患儿的临床资料，以探讨PEW的发生率。根据CKD-PEW的诊断标准，将其分为CKD-PEW组和非PEW组。采用独立样本t检验和卡方检验进行组间比较，并通过多因素Logistic回归分析危险因素。231例患儿中，男138例，女93例，就诊年龄为9.9（7.9，16.0）岁；1期6例，2期14例，3期51例，4期36例，5期124例。共30例（13.0%）CKD-PEW患儿诊断时年龄为7.1（3.8，13.2）岁，其中1期1例，2期1例，3期5例，4期5例，5期18例。非PEW组共201例（87.0%），诊断时年龄为11.8（8.5，12.2）岁，其中1期5例，2期13例，3期46例，4期31例，5期106例。卡方检验和t检验显示，CKD-PEW组的收缩压、舒张压、出生体重和二氧化碳结合力均低于非PEW组（（109±22） （120±20）mmHg（1 mmHg = 0.133 kPa），（72±19） （79±16）mmHg，（2.9±0.5） （3.2±0.6）kg，（17±4） （19±4）mmol/L，t = 2.85、2.14、0.67、2.63，均P<0.05）。多因素Logistic回归分析显示，二氧化碳结合力和出生体重是儿童CKD-PEW的独立保护因素（β = -0.81和-0.36，95%CI分别为-0.90至-0.73和-0.77至-0.17；均P<0.01）；CKD患儿二氧化碳结合力每增加1 mmol/L，PEW风险降低0.187倍，出生体重每增加1 kg，PEW风险降低0.638倍。慢性肾脏病患儿蛋白质能量消耗的发生率低于以往研究。PEW可出现在CKD 1-2期，临床实践中CKD早期应予以关注。低出生体重的CKD患儿易发生PEW，积极纠正代谢性酸中毒可降低CKD-PEW的风险。
