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开始肾替代治疗(RRT)和透析或肾移植之前。对成年人的研究已经证实，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发育和营养的影响尚不明确。成长中儿童的独特需要可能导致肾功能远高于成人营养不良风险的营养不良和生长迟缓。有几种评估肾功能的方法。准确识别有营养不良风险的儿童需要确定最能反映营养状况的肾功能指标。这项研究的目标是：(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，以及(Iii)比较四种估计肾功能的方法，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成分的四组分模型，以及双能量X射线吸收测量和人体测量方法，以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。回归模型将扩大，以确定生长和营养受损的风险因素。Logistic回归和ROC分析将用于对每项肾功能指标区分营养不良患者和非营养不良患者的能力进行定量比较。

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.