ESPN 50th Annual Meeting

ESPN 2017


 
Paediatric Chronic Kidney Disease – Identifying those at Risk from Malnutrition
MATTHEW HARMER 1 RODNEY GILBERT 1 STEVE WOOTTON 2 CAROLINE ANDERSON 1

1- SOUTHAMPTON CHILDRENS HOSPITAL
2- UNIVERSITY OF SOUTHAMPTON
 
Introduction:

Identifying children with Chronic Kidney Disease (CKD) who are at increased risk from malnutrition is difficult due heterogeneity of populations. There is no formalised, agreed process whereby children are determined to be at nutritional risk.

Material and methods:

Children aged 3 and 18 years with CKD (stages 2 to 5D) were screened for risk of malnutrition using nutrition screening tools: Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP); Screening Tool for Risk On Nutritional status and Growth (STRONGkids); Simple Paediatric Nutrition Risk Score (PNRS); and Paediatric Yorkhill Malnutrition Score (PYMS). For comparison, the degree of malnutrition was assessed by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria.

Results:

60 children with CKD were recruited; 46 of whom were conservatively managed, 10 had previous undergone renal transplantation, and 5 were receiving dialysis (4 haemodialysis, 1 peritoneal dialysis). Mean values (with standard deviations) of age, height SDS, weight SDS and BMI SDS for the cohort were 10.7years(±4.0), -1.19(±1.53),-0.42(±1.76), and 0.46(±1.36), respectively. 10 children(17%) had weight SDS<-2 . 1 child(1.7%) was under-weight for height(BMI SDS <-2). 17 children(28%) were short-for-age(height SDS<-2). There was poor concordance between ICD-10 anthropometric definitions of malnutrition risk and all screening tools. Additionally, there was poor inter-tool agreement; with no 2 tools showing a Cohen’s kappa value of greater than 0.2.

Conclusions:

Although discrepancy is expected, to be a clinically useful screening tool, they must be able to identify those at risk, and not miss individuals that require assessment / intervention. Currently used screening tools are not adequate for stratifying nutritional risk, and standardised nutritional assessment is needed, although inadequate resources for this are in place. Attention must be given to a identifying those at risk from nutritional inadequacy; including adiposity. It therefore seems essential to utilise a specialist paediatric renal dietitian.