Abstract
While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.
Highlights
Www.nature.com/scientificreports overweight/obesity at start of chronic peritoneal dialysis (CPD) was 8.9% and 19.7%, respectively
All children and adolescents enrolled in the International Pediatric Peritoneal Dialysis Network (IPPN) registry with initiation of CPD
To further illustrate the interaction of age and Body Mass Index (BMI) standard deviation scores (SDS) with respect to mortality risk on dialysis, we modeled the hazard ratio of death by age for patients with a BMI SDS of −2, 0, and 2 (Fig. 5)
Summary
Www.nature.com/scientificreports overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. The International Pediatric Peritoneal Dialysis Network (IPPN) has been collecting comprehensive clinical and laboratory data in a standardized manner from children undergoing CPD worldwide since 2007. Since these data include detailed anthropometric measures, feeding prescriptions and outcome measures, it provides an opportunity to address the global demographics of nutritional abnormalities in children receiving CPD. The objective of this study was to examine and follow prospectively the nutritional status of 1,001 children commencing CPD around the globe, analyze factors associated with the nutritional status at the start and during the course of dialysis, and to analyze the impact of nutritional abnormalities on patient survival
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