title: Protein energy wasting in children with chronic kidney disease.
abstract: BACKGROUND
  In adults with chronic kidney disease (CKD), protein-energy wasting (PEW) is a risk factor for hospitalization and death. However, PEW in children with CKD is not well characterized or defined.
  
  
  METHODS
  Using data from the Chronic Kidney Disease in Children study, we assessed three alternate definitions of PEW using biochemical parameters, body and muscle mass measurements, and reported appetite as described in adults: (1) a minimal PEW definition (≥2 of the four criteria); (2) a standard PEW definition (≥3 of the four criteria); (3) a modified PEW definition (≥3 of the four criteria plus a pediatric-focused criterion of short stature or poor growth).
  
  
  RESULTS
  Of the 528 children analyzed in this study (median age 12 years, median glomerular filtration rate 45 mL/min/1.73 m(2), 39% female, 18% African American), 7-20% met the spectrum of definitions for PEW. The unadjusted incidence rates for incident hospitalizations were 1.9-, 2.1-, and 2.2-fold higher for those children diagnosed with PEW using the minimal, standard, and modified definitions, respectively (P = 0.08, 0.09 and 0.03). Following adjustment, only the modified PEW definition, which added short stature or poor growth as a criterion, showed modest significance (P = 0.06).
  
  
  CONCLUSIONS
  The inclusion of a criterion based on growth may augment the definition of PEW and improve risk discrimination in children with CKD.
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA, aabraham@jhsph.edu.
authors: Alison G
authors: AG
authors: Abraham
authors: Robert H
authors: RH
authors: Mak
authors: Mark
authors: M
authors: Mitsnefes
authors: Colin
authors: C
authors: White
authors: Marva
authors: M
authors: Moxey-Mims
authors: Bradley
authors: B
authors: Warady
authors: Susan L
authors: SL
authors: Furth
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011502:Protein-Energy Malnutrition / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*