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.

Details

Title
Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network
Author
Schaefer, Franz 1 ; Benner, Laura 2 ; Borzych-Dużałka Dagmara 3 ; Zaritsky, Joshua 4 ; Xu, Hong 5 ; Rees, Lesley 6 ; Antonio, Zenaida L 7 ; Serdaroglu Erkin 8 ; Nakysa, Hooman 9   VIAFID ORCID Logo  ; Patel, Hiren 10 ; Sever Lale 11 ; Vondrak Karel 12 ; Flynn, Joseph 13 ; Rébori Anabella 14 ; Wong, William 15 ; Hölttä Tuula 16 ; Yildirim, Zeynep Yuruk 17 ; Ranchin Bruno 18 ; Grenda Ryszard 19 ; Testa, Sara 20 ; Drożdz Dorota 21 ; Szabo, Attila J 22 ; Eid Loai 23 ; Basu Biswanath 24 ; Vitkevic Renata 25 ; Wong, Cynthia 26 ; Pottoore, Stephen J 27 ; Müller Dominik 28 ; Dusunsel Ruhan 29 ; Celedon Claudia Gonzalez 30 ; Fila, Marc 31   VIAFID ORCID Logo  ; Sartz Lisa 32 ; Sander Anja 2 ; Warady, Bradley A 33 ; Adragna, M 34 ; Coccia, P A 35 ; Suarez, A 36 ; Valles, P G 37 ; Salim, R 38 ; Alconcher, L 39 ; Arbeiter, K 40 ; van, Hoeck K 41 ; Koch, V 42 ; Feber, J 43 ; Harvey, E 44 ; White, C 45 ; Valenzuela, M 46 ; Villagra, J 47 ; Cano, F 48 ; Contreras, M A 49 ; Vogel, A 50 ; Zambrano, P 51 ; Hevia, P 52 ; Chiu, M C 53 ; Ding, Jie 54 ; Vanegas, J J 55 ; Higuita, L M 56 ; Roussey, G 57 ; Ulinski, T 58 ; Krid, S 59 ; Fischbach, M 60 ; Harambat, J 61 ; Samaille Ch 62 ; Büscher, R 63 ; Oh J 64 ; Pape, L 65 ; John, U 66 ; Klaus, G 67 ; Billing, H 68 ; Stafanidis, C 69 ; Papachristou, F 70 ; Bagga, A 71 ; Kanitkar, M 72 ; Sinha, R 73 ; Sethi, S 74 ; Verrina, E 75 ; Vidal, E 76 ; Leozappa, G 77 ; Landau, D 78 ; Ha, I S 79 ; Paik, K H 80 ; Bilal, A 81 ; Sahpazova, E 82 ; Lim, Y N 83 ; Sanchez, Barbosa L 84 ; Groothoff J W 85 ; Konijenberg, Y 86 ; Silva, Y 87 ; Al, Ryami M 88 ; Loza, Munarriz R 89 ; Leszczynska, B 90 ; Szczepanska, M 91 ; Brumariu, O 92 ; Kari, J 93 ; Kruscic, D 94 ; Yap, H K 95 ; Ariceta, G 96 ; Aguirre, M 97 ; Santos, F 98 ; Niwinska-Faryna, B 99 ; Bayazit, A 100 ; Bakkaloglu C A S 101 ; Bakkaloglu, S 102 ; Bilge, I 103 ; Yavascan, O 104 ; Mir, S 105 ; Simkova, Eva 106 ; Christian, M 107 ; Greenbaum, L 108 ; Neu, A 109 ; Askenazi, D 110 ; Al-Akash, A 111 ; Swartz, S 112 ; Brophy, P 113 ; Rheault, M 114 ; Pradhan, M 115 

1  Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany (GRID:grid.7700.0) (ISNI:0000 0001 2190 4373) 
2  Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany (GRID:grid.7700.0) (ISNI:0000 0001 2190 4373) 
3  Medical University of Gdansk, Department of Pediatrics, Nephrology and Hypertension, Gdańsk, Poland (GRID:grid.11451.30) (ISNI:0000 0001 0531 3426) 
4  Nemours/A.I. duPont Hospital for Children, Wilmington, USA (GRID:grid.239281.3) (ISNI:0000 0004 0458 9676) 
5  Children’s Hospital of Fundan University, Shanghai, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443) 
6  Great Ormond Street Hospital, London, United Kingdom (GRID:grid.420468.c) 
7  Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines (GRID:grid.419686.4) (ISNI:0000 0004 0623 9223) 
8  Dr. Behcet Uz Children Research and Educational Hospital, Izmir, Turkey (GRID:grid.419686.4) 
9  Iran University of Medical Sciences, Tehran, Iran (GRID:grid.411746.1) (ISNI:0000 0004 4911 7066) 
10  Nationwide Children’s Hospital, Columbus, USA (GRID:grid.240344.5) (ISNI:0000 0004 0392 3476) 
11  Carrahpasa School of Medicine, Istanbul, Turkey (GRID:grid.240344.5) 
12  University Hospital Motol, Prague, Czech Republic (GRID:grid.412826.b) (ISNI:0000 0004 0611 0905) 
13  Seattle Children’s Hospital, Seattle, USA (GRID:grid.240741.4) (ISNI:0000 0000 9026 4165) 
14  S.E.N.N.I.A.D, Montevideo, Uruguay (GRID:grid.240741.4) 
15  Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand (GRID:grid.414054.0) (ISNI:0000 0000 9567 6206) 
16  HUCH Hospital for Children and Adolescents, Helsinki, Finland (GRID:grid.424664.6) (ISNI:0000 0004 0410 2290) 
17  Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey (GRID:grid.9601.e) (ISNI:0000 0001 2166 6619) 
18  Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France (GRID:grid.413852.9) (ISNI:0000 0001 2163 3825) 
19  Children’s Memorial Health Institute, Warsaw, Poland (GRID:grid.413923.e) (ISNI:0000 0001 2232 2498) 
20  Pediatric nephrology, Dialysis and Transplantation Unit Fondazione IRCCS Ca’ Granda Osp. Maggiore Policlinico, Milan, Italy (GRID:grid.413923.e) 
21  Jagellonian University Medical College, Kraków, Poland (GRID:grid.5522.0) (ISNI:0000 0001 2162 9631) 
22  Semmelweis University, Budapest, Hungary (GRID:grid.11804.3c) (ISNI:0000 0001 0942 9821) 
23  Dubai Hospital, Dubai, United Arab Emirates (GRID:grid.414162.4) (ISNI:0000 0004 1796 7314) 
24  NRS Medical College & Hospital, Kolkata, India (GRID:grid.416241.4) 
25  Children Hospital, affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (GRID:grid.416241.4) 
26  Lucile Packard Children’s Hospital at Stanford, Palo Alto, USA (GRID:grid.414123.1) (ISNI:0000 0004 0450 875X) 
27  Children’s Medical Center Dallas, Dallas, USA (GRID:grid.414196.f) (ISNI:0000 0004 0393 8416) 
28  Nephrology and Metabolism, Charité, Department of Pediatric Gastroenterology, Berlin, Germany (GRID:grid.6363.0) (ISNI:0000 0001 2218 4662) 
29  Erciyes University, Kayseri, Turkey (GRID:grid.411739.9) (ISNI:0000 0001 2331 2603) 
30  Hospital Sotero del Rio, Santiago, Chile (GRID:grid.490390.7) (ISNI:000000040628522X) 
31  CHU Arnaud de Villeneuve, Université de Montpellier, Montpellier, France (GRID:grid.490390.7) 
32  Barnkliniken, Lund, Sweden (GRID:grid.490390.7) 
33  Children’s Mercy Hospital, Kansas City, USA (GRID:grid.239559.1) (ISNI:0000 0004 0415 5050) 
34  Hospital de Pediatria Garrahan, Buenos Aires, Argentina (GRID:grid.414531.6) (ISNI:0000 0001 0695 6255) 
35  Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (GRID:grid.414775.4) (ISNI:0000 0001 2319 4408) 
36  Hospital de Ninos Sor. Maria Ludovica La Plata, La Plata, Argentina (GRID:grid.414544.4) 
37  Hospital Pediatrico Humberto Notti, Mendoza, Argentina (GRID:grid.414544.4) 
38  R.S.A., Salta, Argentina (GRID:grid.414544.4) 
39  Hospital Interzonal General, Bahia Blanca, Argentina (GRID:grid.414544.4) 
40  Medical University Vienna, Vienna, Austria (GRID:grid.22937.3d) (ISNI:0000 0000 9259 8492) 
41  University Hospital Antwerp, Edegem, Belgium (GRID:grid.411414.5) (ISNI:0000 0004 0626 3418) 
42  Instituto da CrianÇa - Hospital das Clinicas FMUSP, Sao Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036) 
43  Children’s Hospital of Eastern Ontario, Ottawa, Canada (GRID:grid.414148.c) (ISNI:0000 0000 9402 6172) 
44  Hospital for Sick Children, Toronto, Canada (GRID:grid.42327.30) (ISNI:0000 0004 0473 9646) 
45  BC Children’s Hospital, Vancouver, Chile (GRID:grid.42327.30) 
46  Hospital Guillermo Grant Benavente, Concepcion, Chile (GRID:grid.490152.b) 
47  Hospital Base, Osorno, Chile (GRID:grid.500224.1) 
48  Hospital Luis Calvo Mackenna, Santiago, Chile (GRID:grid.414793.c) (ISNI:0000 0004 1794 4833) 
49  Roberto del Rio Hospital, Santiago, Chile (GRID:grid.414793.c) 
50  Pontivicia Universidad Catolica de Chile, Santiago, Chile (GRID:grid.7870.8) (ISNI:0000 0001 2157 0406) 
51  Hospital Dr. Gonzales Cortes, Santiago, Chile (GRID:grid.7870.8) 
52  Hospital San Juan de Dios, Santiago, Chile (GRID:grid.413361.2) 
53  Department of Pediatric & Adolescent Medicine, Hong Kong, China (GRID:grid.413361.2) 
54  Peking First Hospital, Beijing, China (GRID:grid.413361.2) 
55  Instituto del Rinon, Medellin, Colombia (GRID:grid.413361.2) 
56  Baxter Servicio al Cliente Colombia, Medellin, Colombia (GRID:grid.413361.2) 
57  CHU Nantes, Nantes, France (GRID:grid.277151.7) (ISNI:0000 0004 0472 0371) 
58  Armand Trousseau Hospital, Paris, France (GRID:grid.413776.0) (ISNI:0000 0004 1937 1098) 
59  Hopital Necker_Enfants Malades, Paris, France (GRID:grid.412134.1) (ISNI:0000 0004 0593 9113) 
60  Children’s Dialysis Center, Strasbourg, France (GRID:grid.412134.1) 
61  Hopital de Enfants, Bordeaux, France (GRID:grid.42399.35) (ISNI:0000 0004 0593 7118) 
62  Hopital Jeanne de Flandre, Lille, France (GRID:grid.414184.c) (ISNI:0000 0004 0593 6676) 
63  Children’s Hospital Essen, Essen, Germany (GRID:grid.414184.c) 
64  University Medical Center, Hamburg, Germany (GRID:grid.13648.38) (ISNI:0000 0001 2180 3484) 
65  Medical School, Hannover, Germany (GRID:grid.10423.34) (ISNI:0000 0000 9529 9877) 
66  Kidney Center for Children and Adolescents, Jena, Germany (GRID:grid.10423.34) 
67  KfH Kidney Center, Marburg, Germany (GRID:grid.10423.34) 
68  Children’s University Hospital, TÜbingen, Germany (GRID:grid.411544.1) (ISNI:0000 0001 0196 8249) 
69  A&P Kyriakou Children’s Hospital, Athens, Greece (GRID:grid.417354.0) 
70  Aristoteles University, Thessaloniki, Greece (GRID:grid.417354.0) 
71  All India Institute of Medical Sciences, New Delhi, India (GRID:grid.413618.9) (ISNI:0000 0004 1767 6103) 
72  Armed Forces Medical College, Pune, India (GRID:grid.413909.6) (ISNI:0000 0004 1766 9851) 
73  Institute of Child Health, Kolkata, India (GRID:grid.414710.7) (ISNI:0000 0004 1801 0469) 
74  The Medicity, Gurgaon, India (GRID:grid.429252.a) (ISNI:0000 0004 1764 4857) 
75  G. Gaslini Institute, Genova, Italy (GRID:grid.419504.d) (ISNI:0000 0004 1760 0109) 
76  Pediatric Nephrology, Dialysis and Transplant Unit, Padova, Italy (GRID:grid.419504.d) 
77  Department of Nefrologia-Urologia, Rome, Italy (GRID:grid.419504.d) 
78  Soroka Medical Center, Beer-Sheva, Israel (GRID:grid.412686.f) (ISNI:0000 0004 0470 8989) 
79  Seoul National University Children’s Hospital, Seoul, Korea (GRID:grid.412482.9) (ISNI:0000 0004 0484 7305) 
80  Samsung Medical Center, Seoul, South Korea (GRID:grid.414964.a) (ISNI:0000 0001 0640 5613) 
81  Rafik Hari University Hospital, Beirut, Lebanon (GRID:grid.414964.a) 
82  Pediatric Clinic, Skopje, Macedonia (GRID:grid.414964.a) 
83  Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (GRID:grid.412516.5) (ISNI:0000 0004 0621 7139) 
84  Pediatric Hospital Medical Center SXXI, Cuahutemoc, Mexico (GRID:grid.412516.5) 
85  Academic Medical Center, Amsterdam, The Netherlands (GRID:grid.5650.6) (ISNI:0000000404654431) 
86  Wilhelmina Children’s Hospital, Utrecht, The Netherlands (GRID:grid.417100.3) (ISNI:0000 0004 0620 3132) 
87  Hospital Infantil de Nicaragua, Managua, Nicaragua (GRID:grid.417100.3) 
88  Royal Hospital, Muscat, Oman (GRID:grid.416132.3) (ISNI:0000 0004 1772 5665) 
89  Cayetano Heredia Hospital, Lima, Peru (GRID:grid.416132.3) 
90  Public Pediatric Teaching Hospital, Warsaw, Poland (GRID:grid.416132.3) 
91  Dialysis Division for Children, Zabrze, Poland (GRID:grid.416132.3) 
92  St. Maria Children’s Hospital, Iasi, Romania (GRID:grid.416132.3) 
93  King Abdul Aziz University Hospital, Jeddah, Saudi Arabia (GRID:grid.412126.2) (ISNI:0000 0004 0607 9688) 
94  University Children’s Hospital, Belgrade, Serbia (GRID:grid.412355.4) (ISNI:0000 0004 4658 7791) 
95  Shaw-NKF-NUH Children’s Kidney Center, Singapore, Singapore (GRID:grid.457383.e) (ISNI:0000 0001 0142 7493) 
96  University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (GRID:grid.411083.f) (ISNI:0000 0001 0675 8654) 
97  Hospital de Cruces, Baracaldo, Spain (GRID:grid.411232.7) (ISNI:0000 0004 1767 5135) 
98  Hospital Universitario Central de Asturias, Oviedo, Spain (GRID:grid.411052.3) (ISNI:0000 0001 2176 9028) 
99  Karolinska University Hospital, Stokholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705) 
100  Cukrova University, Adana, Turkey (GRID:grid.24381.3c) 
101  Hacettepe University, Ankara, Turkey (GRID:grid.14442.37) (ISNI:0000 0001 2342 7339) 
102  Gazi University, Ankara, Turkey (GRID:grid.25769.3f) (ISNI:0000 0001 2169 7132) 
103  Department of Pediatric Nephrology, Capa-Istambul, Istanbul, Turkey (GRID:grid.25769.3f) 
104  Tepecik Children and Research Hospital, Izmir, Turkey (GRID:grid.25769.3f) 
105  Ege University Faculty of Medicine, Izmir-Bornova, Turkey (GRID:grid.8302.9) (ISNI:0000 0001 1092 2592) 
106  Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates (GRID:grid.8302.9) 
107  Children & Young People’s Kidney Unit, Notthingham, United Kingdom (GRID:grid.8302.9) 
108  Children’s Healthcare Pediatric Dialysis Unit, Atlanta, United States (GRID:grid.8302.9) 
109  Johns Hopkins Hospital, Baltimore, UK (GRID:grid.8302.9) 
110  Children’s Hospital of Alabama, Birmingham, UK (GRID:grid.415246.0) (ISNI:0000 0004 0399 7272) 
111  Driscoll Children’s Hospital, Corpus Christi, USA (GRID:grid.414149.d) (ISNI:0000 0004 0383 4967) 
112  Texas Children’s Hospital, Houston, USA (GRID:grid.416975.8) (ISNI:0000 0001 2200 2638) 
113  University of Iowa Children’s Hospital, Iowa, USA (GRID:grid.214572.7) (ISNI:0000 0004 1936 8294) 
114  University of Minnesota Amplatz Children’s Hospital, Minneapolis, USA (GRID:grid.413014.3) (ISNI:0000 0004 0533 2151) 
115  The Children’s Hospital of Philadelphia, Philadelphia, USA (GRID:grid.239552.a) (ISNI:0000 0001 0680 8770) 
Publication year
2019
Publication date
Dec 2019
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-018-36975-z
ProQuest document ID
2194569752
Copyright
This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.