Identifying nutritional gaps in pediatric hemodialysis patients
Kidney failure is relatively rare in children compared to adults, making it more difficult for individual dialysis centers to conduct large-scale studies.
The ability to recognize nutritional gaps in children with kidney disease is essential to effective care planning and long-term condition management. Pediatric patients on dialysis are a particularly fragile population when it comes to nutritional risks, often facing poor appetite, gastrointestinal symptoms and dietary restrictions that make adequate intake challenging to maintain.
In a recent study, experts at Children’s National Hospital addressed a gap in pediatric kidney care by examining whether normalized protein catabolic rate (NPCR), which measures daily dietary protein intake, could be used as a reliable tool to identify compromised nutritional status in pediatric hemodialysis (HD) patients ages 0-12 years old. While NPCR had been studied in adolescents, its usefulness in younger children had not previously been established.
This study will serve as the foundation for future research, with plans already underway to expand this work across multiple centers.
The big picture
The analysis consisted of 758 observations of 58 patients and evaluated nutritional risk using a composite indicator of compromised nutritional status, including low body weight, poor growth, low appetite and biochemical abnormalities. Results of this single-cohort study showed that pediatric HD patients with an NPCR level less than 1.2 had two-fold increased odds of poor nutritional status.
When broken down by age, children 4-12 years-old showed an even stronger association, with four-fold increased odds of compromised nutritional status. This relationship was less clear among infants and toddlers ages 0-3, highlighting an important area for continued research.
The patient impact
Tools to assess nutritional status in young children on dialysis are very limited. As the first study to establish NPCR as a marker of nutritional status for chronic HD patients ages 0-12 – rather than solely focusing on adolescents – this research provides clinicians with a clearer, evidence-based NPCR threshold to help guide interventions for this population.
This guidance is critical during key periods of growth and development and has the potential to improve outcomes as children prepare for kidney transplantation.
Moving the field forward
Kidney failure is relatively rare in children compared to adults, making it more difficult for individual dialysis centers to conduct large-scale studies. As a result, pediatric research in this space is often limited by sample size. This study provides the methodological and clinical foundation for future work.
Building on these findings, leaders at Children’s National are collaborating through the Pediatric Nephrology Research Consortium to coordinate the first multi-center study of NPCR in pediatric HD patients. A larger sample size will allow for more definitive conclusions, particularly for the youngest patient cohort.
Read the full study, “Investigation of normalized protein catabolic rate as a marker of nutritional status in infants and children receiving chronic hemodialysis,” in Pediatric Nephrology. Children’s National contributors include Kristen Sgambat, PhD, RD, Celina Brunson, MD, Anqing Zhang, PhD, and Nicole Salach, DO.
