Abstract: TH-PO605
Malnutrition and Protein Energy Wasting in Pediatric CKD
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Shen, Carol, Columbia University NYP Morgan Stanley Children''s Hospital, New York, New York, United States
- Liebstein, Dana, Columbia University NYP Morgan Stanley Children''s Hospital, New York, New York, United States
- Fernandez, Hilda E., Columbia University NYP Morgan Stanley Children''s Hospital, New York, New York, United States
Background
Malnutrition (malnut) predisposes CKD patients (pts) to poor growth through hormonal & metabolic derangements, decreased appetite & inflammation. Protein energy wasting (PEW) describes a state of decreased protein stores, associated w/ impaired growth and poor outcomes in peds. Few studies investigate the relationship between malnut, PEW & CKD progression in peds pts.
Methods
Retrospective chart review of pts 0 – 25 yrs with CKD stages 1-5 seen in peds renal clinic from 2013 - 2018. Diagnosis of malnut based on the Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. eGFR calculated by revised Schwartz equation. PEW scores (PEWS) assigned based on peds criteria (Abraham A, et al, 2014). Minimal PEW definition requires any positive test in ≥2 of PEWS categories. Linear regression was performed to determine effect of z-score for height (HZ), weight (WZ), BMI (BMIZ), weight-for-length (WLZ) or PEWS on eGFR. Mixed-effects models performed to determine effect of diagnosis of malnut and PEW on change in eGFR. P < 0.05 was significant.
Results
Of 135 pts, 68 (50.3%) were classified as malnut & 50 (37%) met minimal PEW criteria during a median 1.8yrs [0.9-3.5] follow-up. Majority diagnosed w/ malnut were male (65%), white (36%), w/ a median age of 14.2yrs [7.4-17.6], w/ CKD Stage 3 at time of 1st visit (50%) and a congenital anomaly of kidney and urinary tract diagnosis (46%). Majority were diagnosed with malnut based on Decline in Weight/Height Z-score (38%) using 2 data points as indicators. Linear regression showed no significant effect of HZ, WZ, BMIZ, WLZ or PEWS on eGFR. Mixed-effects analysis of eGFR in pts w/ & without diagnosis of malnut demonstrate a significant worsening decline in eGFR for pts w/ malnut (-2.44 vs -1.41ml/min/1.73m^2/yr, p<0.001). Mixed-effects analysis of eGFR w/ diagnosis of malnut showed no significant difference in eGFR decline before or after diagnosis of malnut. Pts who met minimal PEW criteria had a significant worsening decline in eGFR compared to those who did not (-2.44 vs -1.72ml/min/1.73m^2/yr, p<0.001).
Conclusion
Malnutrition and PEW are common in peds with CKD. Our preliminary data demonstrate a trend in mild/moderate CKD for worse eGFR decline in pts with malnut and PEW. Future study will further characterize relationship between malnutrition, PEW and peds CKD outcomes.