Malnutrition in Childhood Chronic Renal Failure

描述（申请人提供）：生长迟缓和营养不良是儿童慢性肾功能不全（CRI）的普遍并发症。许多生长和营养状况的损失发生在透析或肾移植肾替代治疗（RRT）开始之前。对成人的研究已经证实，肾功能下降会导致进行性营养不良，从而增加并发症和死亡的风险。肾功能下降对儿童生长和营养的影响尚未明确。成长中的儿童的独特需求可能导致营养不良和生长迟缓，其肾功能水平远远高于成人营养不良的风险。目前存在几种评估肾功能的方法。准确地识别有营养不良风险的儿童需要测量肾功能，这是最能反映营养状况的指标。本研究的目的是：(I)确定肾功能下降对生长和营养的影响，（II）确定进行性营养不良和生长衰竭的独立危险因素，（III）比较四种评估肾功能的方法，并确定哪种方法最能反映营养状况。这项横断面研究将使用身体组成的四组分模型，以及双能x射线吸收测量和人体测量方法来评估营养状况和生长。肾功能下降对这些参数的影响将通过单变量线性回归进行评估。将扩大回归模型，以确定生长和营养受损的风险因素。Logistic回归和ROC分析将用于提供每个肾功能测量的能力的定量比较，以区分有无营养不良的患者。

DESCRIPTION (provided by applicant): Growth retardation and malnutrition are pervasive complications of childhood chronic renal insufficiency (CRI). Many of the losses in growth and nutritional status occur before initiation of renal replacement therapy (RRT) with dialysis or kidney transplantation. Studies in adults have established that declining renal function results in progressive malnutrition with a consequent increased risk of complications and death. The influence of declining renal function on growth and nutrition in children has not been characterized. The unique needs of growing children may result in the presence of malnutrition and growth retardation at a level of renal function well above that identified as a risk for malnutrition in adults. Several methods of estimating renal function exist. Accurate identification of children at risk for malnutrition requires that the measure of renal function, which best reflects nutritional status be determined. The goals of this study are: (I) To determine the impact of declining renal function on growth and nutrition, (II) to identify independent risk factors for progressive malnutrition and growth failure, and (III) To compare four methods of estimating renal function and to determine which best reflects nutritional status. This cross-sectional study will use a 4-component model of body composition, as well as dual energy X-ray absorptiometry and anthropometric methods, to evaluate nutritional status and growth. The impact of declining renal function on these parameters will be assessed by univariate linear regression. The regression model will be expanded to identify risk factors for impaired growth and nutrition. Logistic regression and ROC analysis will be used to provide a quantitative comparison of each renal function measure's ability to discriminate between patients with and without malnutrition.