{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T06:08:46Z","timestamp":1775628526219,"version":"3.50.1"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Protein-energy wasting (PEW) is a critical complication in children with advanced chronic kidney disease (CKD), yet its burden remains poorly characterized in pediatric populations. This observational study aimed to determine the prevalence and clinical correlates of PEW in children with CKD stages 3-5D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 170 children (aged 0\u201318 years) treated at Beijing Children's Hospital from January 2015 to December 2024. PEW was diagnosed using modified pediatric-specific criteria, which is fully aligned with the core nutritional assessment and management principles of the 2020 KDOQI Clinical Practice Guidelines for Nutrition in CKD, requiring growth retardation (height SDS\u2009&amp;lt;\u2009\u22121.88 or growth velocity &amp;lt;10th percentile) plus two additional parameters (hypoalbuminemia, reduced intake, weight loss, or muscle wasting). Data on anthropometry, biochemical markers, three consecutive 24-h dietary recalls (standardized), and nutritional interventions (oral nutritional supplements, dietary counseling, specialist referral) were analyzed. A multivariate linear regression analysis was performed to assess PEW as an independent predictor of height velocity after adjusting for metabolic acidosis, GH\/IGF-1 axis resistance and CKD-MBD; Spearman correlation and logistic regression analyses were conducted to explore the association between inflammatory markers (hs-CRP) and PEW.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of PEW was 30.6%, increasing with CKD severity: 0% (stage 3), 25.9% (stage 4), 39.7% (stage 5 non-dialysis), and 20.0% (stage 5D). Hypoalbuminemia (73.1%) and reduced intake (73.1%) were predominant features. Short stature (height SDS\u2009&amp;lt;\u2009\u22121.88) affected 45.3% of the cohort. Dialysis patients exhibited lower PEW rates than non-dialysis stage 5 counterparts (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), a disparity associated with standardized nutritional interventions (oral nutritional supplements, regular dietary counseling) in 5D patients (86.7% coverage) vs. low intervention rates in stage 5 non-dialysis patients (12.8% coverage). Over 46% of stage 5 patients were not on dialysis, primarily due to delayed referral or parental preference, which further contributed to inadequate nutritional management in this subgroup. PEW was an independent predictor of impaired height velocity after adjusting for confounders (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.32,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001); hs-CRP levels were positively correlated with PEW scores (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.41,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), and elevated hs-CRP (&amp;gt;3\u2005mg\/L) was an independent risk factor for PEW (OR\u2009=\u20092.86, 95% CI: 1.52\u20135.38,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PEW is highly prevalent in advanced pediatric CKD, driven by inflammation and nutritional deficits, and acts as an independent predictor of growth retardation. Early screening and stage-specific, evidence-based dietary and pharmacological interventions in accordance with the 2020 KDOQI guidelines are imperative to mitigate morbidity, particularly for stage 5 non-dialysis patients with low access to standardized nutritional care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1671377","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:31:51Z","timestamp":1775626311000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The burden of protein-energy wasting in children with CKD3-5D: an observational study"],"prefix":"10.3389","volume":"14","author":[{"given":"Ying","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Beijing Children's Hospital, Capital Medical University , Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Children's Hospital, Capital Medical University , Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeping","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Children's Hospital, Capital Medical University , Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1159\/000513698","article-title":"The 2020 updated KDOQI clinical practice guidelines for nutrition in chronic kidney disease","volume":"50","author":"Ikizler","year":"2021","journal-title":"Blood Purif"},{"key":"B2","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1038\/sj.ki.5002585","article-title":"A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease","volume":"73","author":"Fouque","year":"2008","journal-title":"Kidney Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1007\/s00467-014-2768-9","article-title":"Protein energy wasting in children with chronic kidney disease","volume":"29","author":"Abraham","year":"2014","journal-title":"Pediatr Nephrol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S49","DOI":"10.1053\/j.jrn.2023.07.006","article-title":"Nutrition in children with chronic kidney disease: how to thrive?","volume":"33","author":"Mak","year":"2023","journal-title":"J Ren Nutr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1111\/ped.13642","article-title":"Nutrition imbalance in Chinese chronic kidney disease children","volume":"60","author":"Wang","year":"2018","journal-title":"Pediatr Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"487","DOI":"10.3760\/cma.j.issn.0578-1310.2009.07.003","article-title":"Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years","volume":"47","author":"Li","year":"2009","journal-title":"Chin J Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"493","DOI":"10.3760\/cma.j.issn.0578-1310.2009.07.004","article-title":"Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years","volume":"47","author":"Li","year":"2009","journal-title":"Chin J Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"274","DOI":"10.5527\/wjn.v5.i3.274","article-title":"Inflammation and nutrition in children with chronic kidney disease","volume":"5","author":"Tu","year":"2016","journal-title":"World J Nephrol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/nu14204297","article-title":"Evolving concepts on inflammatory biomarkers and malnutrition in chronic kidney disease","volume":"14","author":"Graterol","year":"2022","journal-title":"Nutrients"},{"key":"B10","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1681\/ASN.2010060603","article-title":"Association of chronic kidney disease with muscle deficits in children","volume":"22","author":"Foster","year":"2011","journal-title":"J Am Soc Nephrol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/ncp.10658","article-title":"Chronic kidney disease and nutrition support","volume":"36","author":"Chan","year":"2021","journal-title":"Nutr Clin Pract"},{"key":"B12","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/MOP.0000000000000070","article-title":"Growth in children with chronic kidney disease","volume":"26","author":"Ingulli","year":"2014","journal-title":"Curr Opin Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.ekir.2017.01.002","article-title":"Associations of protein-energy wasting syndrome criteria with body composition and mortality in the general and moderate chronic kidney disease populations in the United States","volume":"2","author":"Beddhu","year":"2017","journal-title":"Kidney Int Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"635","DOI":"10.5114\/aoms.2017.67283","article-title":"Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years","volume":"13","author":"Adamczuk","year":"2017","journal-title":"Arch Med Sci"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1671377\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:31:53Z","timestamp":1775626313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1671377\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":14,"alternative-id":["10.3389\/fped.2026.1671377"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1671377","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]},"article-number":"1671377"}}