Malnutrition Patterns in Children with Chronic Kidney Disease

Abstract

Malnutrition is frequent in children with chronic kidney disease (CKD). Apart from undernutrition and protein energy wasting (PEW), overnutrition prevalence is rising, resulting in fat mass accumulation. Sedentary behavior and unbalanced diet are the most important causal factors. Both underweight and obesity are linked to adverse outcomes regarding renal function, cardiometabolic risk and mortality rate. Muscle wasting is the cornerstone finding of PEW, preceding fat loss and may lead to fatigue, musculoskeletal decline and frailty. In addition, clinical data emphasize the growing occurrence of muscle mass and strength deficits in patients with fat mass accumulation, attributed to CKD-related wasting processes, reduced physical activity and possibly to obesity-induced inflammatory diseases, leading to sarcopenic obesity. Moreover, children with CKD are susceptible to abdominal obesity, resulting from high body fat distribution into the visceral abdomen compartment. Both sarcopenic and abdominal obesity are associated with increased cardiometabolic risk. This review analyzes the pathogenetic mechanisms, current trends and outcomes of malnutrition patterns in pediatric CKD. Moreover, it underlines the importance of body composition assessment for the nutritional evaluation and summarizes the advantages and limitations of the currently available techniques. Furthermore, it highlights the benefits of growth hormone therapy and physical activity on malnutrition management.

Involuntary Falls in Patients with Chronic Kidney Diseases on Nephrology Wards: Research Advances and Future Perspectives

“…28,29 Second, CKD disrupts glucose, fat, and protein metabolism, leading to insufficient energy supply and subsequent muscle tissue atrophy. 30,31 Third, CKD induces chronic inflammatory and oxidative stress, triggering the release of inflammatory factors that inhibit protein synthesis and promote protein catabolism, ultimately resulting in muscle atrophy. 28,31 Lastly, CKD patients often experience fatigue, weakness, and reduced exercise endurance, which restricts physical activity and exacerbates muscle atrophy.…”

Bone Disorders in Pediatric Chronic Kidney Disease: A Literature Review

“…Furthermore, it is recent knowledge that the maturation of the skeleton is accompanied by the development of muscle mass. In particular, it is believed that the latter anticipates bone development, representing a crucial element for bone health during childhood and adolescence (musculoskeletal axis) [14].…”

“…Patients with CKD show muscle atrophy and weakness in 7-20% of cases, especially in the advanced stages of the disease [8]. The resulting osteo-sarcopenia exposes them to a greater risk of fractures, disability, and hospitalization [14]. Again, vitamin D deficiency and elevated PTH levels have a negative effect on muscle.…”

“…A lot of data suggest that regular and early implementation of both aerobic and resistance exercise programs in children and adolescent with chronic kidney disease have positive effects on muscle function, exercise tolerance, and quality of life. Physical activity is highly encouraged in CKD patients; resistance exercise promotes muscle mass and strength, while endurance training enhances physical performance and exercise capacity [14].…”

Assessing protein‑energy wasting in chronic kidney disease

“…Following the identification of these problems, a nutritionist should be contacted to create a strategy for controlling the PEW. 21 A thorough diet specifically designed to fit the patient's requirements, any required nutritional supplements, and counselling about dietary changes, symptom management, and psychological support should all be part of this strategy.…”