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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 67

Nutritional and Metabolic Complications in Children with Chronic Kidney Disease


Consultant Nephrologist, Department of Nephrology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_4_19

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How to cite this article:
Ali US. Nutritional and Metabolic Complications in Children with Chronic Kidney Disease. J Renal Nutr Metab 2018;4:67

How to cite this URL:
Ali US. Nutritional and Metabolic Complications in Children with Chronic Kidney Disease. J Renal Nutr Metab [serial online] 2018 [cited 2019 Jul 15];4:67. Available from: http://www.jrnm.in/text.asp?2018/4/3/67/256822



Nutritional inadequacy is seen commonly in children with chronic kidney disease (CKD). This can have an adverse impact on linear growth, sexual maturation, and neurocognitive development. Whereas protein–energy malnutrition (PEM) is common in the developing world in non-CKD patients, CKD patients often have protein–energy wasting (PEW). PEM occurs due to dietary nutritional deficiencies and can be corrected by nutritional rehabilitation. It is characterized by hunger, low energy expenditure, and wasting of fat stores with preservation of muscle mass. In contrast, PEW is a maladaptive state characterized by poor appetite, increased energy expenditure, and decreased protein stores and muscle mass with relative preservation of fat mass. It is caused by a combination of nutritional deficits, uremic toxins, and inflammatory processes that characterize CKD. Uremic toxins that may contribute are acidosis, anemia, high phosphorous, high parathormone, insulin resistance, altered growth hormone signaling, and neurohumoral abnormalities in leptin and ghrelin. Oxidative stresses and proinflammatory cytokines are other contributory factors. Nutritional rehabilitation improves, but does not totally resolve the PEW in CKD.

The prevalence of PEW in children varies from 5% to 65% in different studies. This variation is may be due to the varying socioeconomic and health-care systems as well as due to the different criteria used to diagnose PEW. Studies in India are scarce. The prevalence seems to be higher and varies from 60% to 76%. At present, there is no clear scoring system for PEW in children. Careful evaluation is needed to assess dietary adequacy, anthropometry deficits, biochemical changes, and decrease of muscle mass. Poor growth, dietary protein deficits, and reduced muscle mass are the most frequently seen findings in children with CKD who have PEW. PEW is associated with poor linear growth, cardiovascular morbidity, increased risk of hospitalization, and higher mortality.






 

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