Association of chronic kidney disease with undernutrition in the pediatric age group: preventative nutrition approaches

Chronic kidney disease is progressive and irreversible. If the plasma glomerular filtration rate is less than 60 ml/min/1.73 m² for more than 3 months, this situation is defined as chronic kidney disease. Although chronic kidney disease is rare in the pediatric age group, it can have many major complications. Due to kidney failure, increased levels of uremic toxins and proinflammatory cytokines and dysregulated appetite-related hormone levels are seen in cases of pediatric chronic kidney disease. All these situations are associated with decreased appetite and increased catabolism. Moreover, in both hemodialysis and peritoneal dialysis, there is a loss of many beneficial nutrients such as protein. As a result of low appetite and dialysis treatment-related nutrient loss, undernutrition risk increases in these patients. Many studies in the current literature indicate that chronic kidney disease is associated with increased undernutrition prevalence and risk in pediatric patients. Also, it is known that medical nutrition treatment plays a key role in preventing complications, undernutrition, progression of disease, and the need for renal transplantation, thus decreasing treatment costs. Therefore, medical nutrition treatment designed by a dietitian, which is compliable with diagnosis, laboratory and physical findings, treatment model, and growth and development status, is necessary. With this in mind, this narrative review article aims to discuss the associated effects of chronic kidney disease on undernutrition and also give detailed information about preventative medical nutrition approaches.