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Cachexia in children with chronic kidney disease

challenges in diagnosis and treatment

Mak, Robert H.

Current Opinion in Supportive and Palliative Care: December 2016 - Volume 10 - Issue 4 - p 293–297
doi: 10.1097/SPC.0000000000000217
CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Florian Strasser
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Purpose of review Although cachexia is highly prevalent in adult patients with chronic kidney disease (CKD), it is understudied and less well characterized in children. Recent evidence suggests that cachexia is also prevalent in children with CKD but presents challenges in diagnosis and treatment.

Recent findings A study from the CKD in children cohort showed that CKD cachexia or protein-energy wasting, using modified pediatric diagnostic criteria, such as lack of expected weight gain instead of weight loss and BMI for height age, had a prevalence of 7–20%. When growth indices such as height SD score (SDS)/height velocity SDS was included in the criteria, cachexia or PEW correlated with the morbidity outcome of increased hospitalization risk in children with CKD. Conversely, aggressive nutritional supplementation in children with advanced CKD, with nasogastric or gastric tube feeding, led to prevalence of obesity over that of cachexia. Body habitus of underweight and obesity have been shown to be associated with the worst clinical outcomes in both adults and children with CKD.

Summary Optimal nutritional therapy remains the mainstay of treatment of cachexia in CKD children with therapeutic goals of maintaining BMI as well as linear growth within the normal range.

Division of Pediatric Nephrology, University of California, San Diego; Rady Children's Hospital, San Diego, California, USA

Correspondence to Robert H. Mak, MD, PhD, Division of Pediatric Nephrology, University of California, San Diego, 9500 Gilman Drive, MC0630, La Jolla, CA 92093-0630, USA. E-mail: romak@ucsd.edu

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