Assessment and management of obesity and metabolic syndrome in children with CKD stages 2–5 on dialysis and after kidney transplantation—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Stabouli, Stella; Polderman, Nonnie; Nelms, Christina L.; Paglialonga, Fabio; Oosterveld, Michiel J. S.; Greenbaum, Larry A.; Warady, Bradley A.; Anderson, Caroline; Haffner, Dieter; Desloovere, An; Qizalbash, Leila; Renken-Terhaerdt, José; Tuokkola, Jetta; Walle, Johan Vande; Shaw, Vanessa; Mitsnefes, Mark; Shroff, Rukshana

doi:10.1007/s00467-021-05148-y

Cited by 21 publications

(9 citation statements)

References 116 publications

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“…In the pediatric population, having a pedometer with realistic goals like taking 500 steps/day above baseline has been found to significantly reduce BMI and to increase patients' subjective health and quality of life ( 40 ). It is also advisable to minimize screen time and promote other positive psychosocial influences, such as family meals, mindfulness during eating, stress management and emotional well-being, in order to prevent the onset of obesity ( 41 ).…”

Section: Non-pharmacological Therapymentioning

confidence: 99%

Management of pediatric obesity as a pathway towards kidney transplantation

Altemose,

Nailescu

2024

Front. Pediatr.

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Obesity is an increasing problem in pediatrics, leading to cardiovascular, metabolic and psychosocial complications. Additionally, for patients with chronic kidney disease (CKD), obesity can lead to CKD progression towards end-stage renal disease (ESRD) needing renal-replacement therapy (RRT). It is well-established that the optimal type of RRT for children with ESRD is kidney transplantation, as it provides significantly better life expectancy and quality of life. Unfortunately, pediatric patients with CKD/ESRD and obesity face barriers getting to kidney transplantation and often remain on dialysis for a long time, which negatively impacts their life expectancy and quality of life. One barrier to kidney transplant is that Body Mass Index (BMI) is still considered by most transplant centers as the main criterion for obesity assessment, although more recent evidence suggests that BMI is not the best measure of adiposity. Clearcut evidence is lacking that obesity has a long-term negative impact upon the graft. Another barrier to transplant can be bias on the part of referring providers that can deter or delay referral to an obesity treatment program. Our article describes the barriers that pediatric obese patients with CKD and ESRD face in their way towards kidney transplantation. In addition, our article encourages pediatric nephrologists to early refer their patients with CKD and ESRD who suffer from obesity to a specialized obesity treatment program and/or bariatric surgery. Our article also describes the treatment options for pediatric patients with CKD and ESRD who suffer from obesity in order to make them eligible for a kidney transplant.

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Section: Non-pharmacological Therapymentioning

confidence: 99%

Management of pediatric obesity as a pathway towards kidney transplantation

Altemose,

Nailescu

2024

Front. Pediatr.

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“…Anthropometric data [weight, height, and body mass index (BMI)] were adjusted according to the Turkish normative values and expressed as their SDS values (15). Obesity defined as BMI > + 2 SD for height-age (16).…”

Section: Study Design and Populationmentioning

confidence: 99%

Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

Yilmaz,

Saygili,

Canpolat

et al. 2024

Front. Pediatr.

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IntroductionIn the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups.MethodsThis multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5–18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV.ResultsMedian (Q1-Q3) age of the patients was 6.0 (2.0–10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p > 0.05 for all).DiscussionThis study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies.

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“…81 The Pediatric Renal Nutrition Taskforce (PRNT, an international team of pediatric renal dietitians and pediatric nephrologists) recently developed clinical practice recommendations for the nutritional management of children with CKD including those after KTx. 82 They include CKD-specific non-pharmacological treatment, including diet, physical activity, and behavior modifications.…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

“…Non‐pharmacological/lifestyle measures such as reduction of body weight in overweight/obesity, reduction of salt intake, or regular physical activity should be encouraged even during antihypertensive drug therapy as they target the risk factors not only for HTN but also for cardiovascular morbidity and mortality (obesity, increased salt intake, physical inactivity) 81 . The Pediatric Renal Nutrition Taskforce (PRNT, an international team of pediatric renal dietitians and pediatric nephrologists) recently developed clinical practice recommendations for the nutritional management of children with CKD including those after KTx 82 . They include CKD‐specific non‐pharmacological treatment, including diet, physical activity, and behavior modifications.…”

Section: Treatment Of Hypertensive Children After Kidney Transplantationmentioning

confidence: 99%

Hypertension in pediatric kidney transplantation

Seeman

Myette

Feber

2023

Pediatric Transplantation

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Arterial hypertension (HTN) in children after kidney transplantation is an important risk factor not only for graft loss but also for cardiovascular morbidity and mortality. The prevalence of posttransplant HTN ranges between 60% and 90%. The etiology of posttransplant HTN is multifactorial and includes residual chronic native kidney disease, immunosuppressive therapy, and chronic allograft dysfunction among other causes. Clinic blood pressure (BP) should be measured at each outpatient visit. However, ambulatory blood pressure monitoring (ABPM) is the gold standard method for BP evaluation in children after kidney transplantation, as it often reveals masked and nocturnal HTN; given this, it should be regularly performed in each transplanted child. All classes of antihypertensive drugs are used in the treatment of posttransplant HTN because it has never been proven that one class is better than another. However, in several retrospective studies, the use of calcium channel blockers is associated with better graft function. The optimal target BP for transplanted children is still a matter of debate; it is recommended to target the same BP as for healthy children, that is, <95th percentile. Control of HTN in transplanted children remains poor – only 20%–50% of treated children have normal BP. There is a great potential for improvement of antihypertensive treatment that could potentially result in improvement of both graft and patient survival in children after kidney transplantation.

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Assessment and management of obesity and metabolic syndrome in children with CKD stages 2–5 on dialysis and after kidney transplantation—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Cited by 21 publications

References 116 publications

Management of pediatric obesity as a pathway towards kidney transplantation

Management of pediatric obesity as a pathway towards kidney transplantation

Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

Hypertension in pediatric kidney transplantation

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