Underweight, overweight and obesity in paediatric dialysis and renal transplant patients

Bonthuis, Marjolein; Stralen, Karlijn J. van; Verrina, Enrico; Groothoff, Jaap W.; Melgar, Á. Alonso; Edefonti, Alberto; Fischbach, Michel; Mendes, Patrícia; Молчанова, Е. А.; Paripović, Dušan; Peco-Antić, Amira; Printza, Nikoleta; Rees, Lesley; Rubik, Jacek; Stefanidis, Constantinos J.; Sinha, Manish D.; Zagożdżon, Ilona; Jager, Kitty J.; Schaefer, Franz

doi:10.1093/ndt/gft259

Cited by 56 publications

(38 citation statements)

References 34 publications

(68 reference statements)

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“…Protein energy wasting in children in the United States with chronic renal insufficiency ranges from 7% to 20% . Recent examinations of two large databases found that 6% and 10% of patients beginning renal replacement therapy were underweight in Europe and the United States, respectively . Children on maintenance dialysis for <1 year were more likely to be underweight than were those who spent 1–3 years on dialysis .…”

Section: Discussionmentioning

confidence: 99%

“…Recent examinations of two large databases found that 6% and 10% of patients beginning renal replacement therapy were underweight in Europe and the United States, respectively . Children on maintenance dialysis for <1 year were more likely to be underweight than were those who spent 1–3 years on dialysis . Thus, a small but important proportion of children with chronic kidney disease and ESRD appear to be undernourished, and this may have important clinical implications.…”

Section: Discussionmentioning

confidence: 99%

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Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Ettenger

Chin

Kesler

et al. 2017

American Journal of Transplantation

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The Immune Development in Pediatric Transplantation (IMPACT) study was conducted to evaluate relationships between alloimmunity, protective immunity, immune development, physical parameters and clinical outcome in children undergoing kidney transplantation. We prospectively evaluated biopsy-proven acute rejection (BPAR), de novo donor specific antibody (dnDSA) formation, viremia, viral infection, T cell immunophenotyping and BMI/weight Z scores in the first year post-transplant in 106 pediatric kidney transplant recipients. Outcomes were excellent with no deaths and 98% graft survival. Rejection and dnDSA occurred in 24% and 22% respectively. Pre-transplant CMV and EBV serologies and subsequent viremia were unrelated to BPAR or dnDSA. Viremia occurred in 73% of children (EBV, 34%; CMV, 23%; BK, 23%; and JC, 21%). Memory lymphocyte phenotype at baseline was not predictive of alloimmune complications. Patients who developed viral infection had lower weight (−2.1) (p=0.028) and BMI (−1.2) (p=0.048) Z scores at transplant. The weight difference persisted to 12 months compared to patients without infection (p=0.038). These data indicate that there is a high prevalence of viral disease following pediatric kidney transplantation, and underweight status at transplant appears to be a risk factor for subsequent viral infection. The occurrence of viremia/viral infection is not associated with alloimmune events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Ettenger

Chin

Kesler

et al. 2017

American Journal of Transplantation

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“…It is possible that a combination of poor appetite and decreased height or BMI led to interventions such has high calorie foods or supplements, appetite stimulants or tube feedings. Overweight and obesity are not uncommon in patients with CKD [19] with 34% of patients from the CKiD cohort having BMI above the 85 th percentile for age and gender at their first visit. We could speculate that some patients with good appetites may have been trying to lose weight.…”

Section: Discussionmentioning

confidence: 99%

Perceived appetite and clinical outcomes in children with chronic kidney disease

et al. 2016

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Background Children with chronic kidney disease (CKD) may have impaired caloric intake through a variety of mechanisms, with decreased appetite as a putative contributor. In adult CKD, decreased appetite has been associated with poor clinical outcomes. There is limited information about this relationship in pediatric CKD. Methods 879 participants of the Chronic Kidney Disease in Children (CKiD) study were studied. Self-reported appetite was assessed annually and categorized as very good, good, fair, or poor/very poor. The relationship between appetite and iohexol or estimated glomerular filtration rate (ieGFR), annual changes in anthropometrics z-scores, hospitalizations, emergency room visits, and quality of life were assessed. Results An ieGFR< 30 ml/min per 1.73m2 was associated with a 4.46 greater odds (95% confidence interval: 2.80, 7.09) of having a worse appetite than those with ieGFR >90. Appetite did not predict changes in height, weight, or BMI z-scores. Patients not reporting a very good appetite had more hospitalizations over the next year than those with a very good appetite. Worse appetite was significantly associated with lower parental and patient reported quality of life. Conclusions Self-reported appetite in children with CKD worsens with lower ieGFR and is correlated with clinical outcomes, including hospitalizations and quality of life.

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“…Height values were normalized to standard deviation scores (SDS) for chronological age, according to recent national growth charts or growth charts for Northern or Southern European countries [18]. Body mass index (BMI) was calculated as weight/height 2 and expressed according to chronological age (0-1 years) or heightage (≥2 years) [19]. Reference charts from the World Health Organization were used to calculate SDS values for BMI [20,21].…”

Section: Definition Of Variablesmentioning

confidence: 99%

Timing of renal replacement therapy does not influence survival and growth in children with congenital nephrotic syndrome caused by mutations in NPHS1: data from the ESPN/ERA-EDTA Registry

et al. 2016

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Underweight, overweight and obesity in paediatric dialysis and renal transplant patients

Cited by 56 publications

References 34 publications

Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Perceived appetite and clinical outcomes in children with chronic kidney disease

Timing of renal replacement therapy does not influence survival and growth in children with congenital nephrotic syndrome caused by mutations in NPHS1: data from the ESPN/ERA-EDTA Registry

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