20 - Evaluation of Protein-Energy Wasting in Pediatric Chronic Dialysis Patients

Poster Number: 20
Publication Number: 20.1514

Background: Protein–energy wasting (PEW) in end stage kidney disease (ESKD) is the consequence of a combination of insufficient nutrient intake, uremic toxins, inflammation, and superimposed catabolism. The diagnosis of malnutrition is based upon biochemical measures, anthropometric parameters, and dietary history; PEW is further defined as malnutrition refractory to nutritional supplementation.
In pediatric dialysis patients, growth is a sensitive marker of nutritional adequacy, which we assessed using the Gomez and Waterlow criteria as well as the American Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition screening tool.

Objective: To determine the efficacy of adding growth assessment in evaluating nutritional status in pediatric patients undergoing chronic dialysis.

Design/Methods: Over two separate three-month periods, nutrition status of pediatric patients on peritoneal dialysis (PD) or hemodialysis (HD) were assessed using the Waterlow and Gomez classification systems. The results of these were compared with serum albumin, growth percentiles, and dialysis adequacy (measured by Kt/V) metrics in the same period, and then across the two periods.

Results: The ASPEN screening tool was not used due to lack of reliable dietary recall.
15 patients were included in the first three month period. One patient had inadequate total Kt/V and four patients had inadequate serum albumin. No patients had a BMI below the third percentile. The Gomez classification noted malnutrition in ten patients, six without other abnormal measures. Waterlow classifications noted stunting in 11 patients (73%), and two patients (13%) with wasting.
17 patients were included in the second three month period. All patients had adequate total Kt/V and two patients had inadequate serum albumin. Gomez noted malnutrition in nine patients, seven without other abnormal measures. Waterlow classifications noted stunting in 12 patients (71%), and one patient (6%) with wasting.

Conclusion(s): The addition of growth assessments provide additional insight into a patient’s nutritional status and potential need for intervention, and also detect patients with inadequate nutrition that would be missed by these standard measures. While no intervention was performed, increased attention to nutritional status corresponded with decreased rates and severity of malnutrition and stunting.
In our patient population, stunting was very common, and weight is often decreased for age-based norms. When height is factored into the weight evaluation, the severity is lessened, reinforcing the impact of stunted vertical growth in patients on chronic dialysis.