Background <p>Children with kidney failure are at risk for compromised nutritional status due to a variety of challenges. Normalized protein catabolic rate (NPCR) below 1&#xa0;g/kg/day has been associated with weight loss in adolescent patients on chronic hemodialysis. We sought to establish NPCR as a marker of nutritional status in patients on hemodialysis under age 13&#xa0;years.</p> Methods <p>A longitudinal retrospective cohort study was conducted to investigate NPCR as a marker of a composite indicator of compromised nutritional status (MINI) in infants and children (0–12&#xa0;years old) who received chronic hemodialysis between 2002 and 2023. Generalized linear mixed effect models were applied to explore associations between MINI and NPCR across the study cohort (0–12&#xa0;years) and after age stratification (0–3&#xa0;years and 4–12&#xa0;years).</p> Results <p>The analysis included 758 observations of 58 patients with median age 8 (IQR 3,11) years. Compromised nutritional status was identified in 35/58 patients at 235/758 time points according to the composite definition of MINI. In children 0–12&#xa0;years, NPCR &lt; 1.2 was associated with approximately twofold increased odds of MINI (<i>p</i> = 0.04), adjusted for time on dialysis and Kt/V. After stratifying by age, children ages 4–12&#xa0;years with NPCR &lt; 1.2 had approximately fourfold higher odds of MINI (<i>p</i> = 0.003).</p> Conclusions <p>NPCR &lt; 1.2&#xa0;g/kg/d was associated with a composite indicator of compromised nutritional status in this single-center retrospective analysis of the largest sample of hemodialysis patients under the age 13 to date. Multicenter studies are needed to verify these findings.</p> Graphical abstract <p></p>