Malnutrition Patterns in Children with Chronic Kidney Disease

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.

Automated summary

Malnutrition is common in children with chronic kidney disease (CKD), with both undernutrition and overnutrition prevalent. Muscle wasting is the key feature of protein energy wasting (PEW), preceding fat loss and leading to fatigue and musculoskeletal decline. CKD-related wasting processes, reduced physical activity, and obesity-induced inflammatory diseases contribute to the accumulation of fat mass and deficits in muscle mass and strength. Abdominal obesity is also prevalent in children with CKD, increasing cardiometabolic risk. This review emphasizes the importance of body composition assessment, discusses the pathogenetic mechanisms, and highlights the benefits of growth hormone therapy and physical activity in managing malnutrition in pediatric CKD.