title: Cachexia and protein-energy wasting in children with chronic kidney disease.
abstract: Children with chronic kidney disease (CKD) are at risk for "cachexia" or "protein-energy wasting" (PEW). These terms describe a pathophysiologic process resulting in the loss of muscle, with or without loss of fat, and involving maladaptive responses, including anorexia and elevated metabolic rate. PEW has been defined specifically in relation to CKD. We review the diagnostic criteria for cachexia and PEW in CKD and consider the limitations and applicability of these criteria to children with CKD. In addition, we present an overview of the manifestations and mechanisms of cachexia and PEW. A host of pathogenetic factors are considered, including systemic inflammation, endocrine perturbations, and abnormal neuropeptide signaling, as well as poor nutritional intake. Mortality risk, which is 100- to 200-fold higher in patients with end-stage renal disease than in the general population, is strongly correlated with the components of cachexia/PEW. Further research into the causes and consequences of wasting and growth retardation is needed in order to improve the survival and quality of life for children with CKD.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA, USA. romak@ucsd.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Mak
authors.forename: Wai W
authors.initials: WW
authors.lastname: Cheung
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhan
authors.forename: Qian
authors.initials: Q
authors.lastname: Shen
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Foster
mesh_terms: D000855:Anorexia / Q000209:etiology; D015992:Body Mass Index; D002100:Cachexia / Q000209:etiology*; D002648:Child; D002908:Chronic Disease; D002149:Energy Intake; D004734:Energy Metabolism; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D011502:Protein-Energy Malnutrition / Q000209:etiology*; D019282:Wasting Syndrome / Q000209:etiology*; D015431:Weight Loss