While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.

Barnkliniken Lund Sweden

Carrahpasa School of Medicine Istanbul Turkey

Center for Pediatrics and Adolescent Medicine Heidelberg Germany

Children Hospital affiliate of Vilnius University Hospital Santaros Klinikos Vilnius Lithuania

Children's Hospital of Fundan University Shanghai China

Children's Medical Center Dallas Dallas Tx USA

Children's Memorial Health Institute Warsaw Poland

Children's Mercy Hospital Kansas City MO USA

CHU Arnaud de Villeneuve Université de Montpellier Montpellier France

Department of Nephrology Starship Children's Hospital Auckland New Zealand

Department of Pediatric Gastroenterology Nephrology and Metabolism Charité Berlin Germany

Department of Pediatric Nephrology National Kidney and Transplant Institute Quezon City Philippines

Dr Behcet Uz Children Research and Educational Hospital Izmir Turkey

Dubai Hospital Dubai United Arab Emirates

Erciyes University Kayseri Turkey

Great Ormond Street Hospital London United Kingdom

Hospital Sotero del Rio Santiago Chile

HUCH Hospital for Children and Adolescents Helsinki Finland

Institute of Medical Biometry and Informatics University of Heidelberg Heidelberg Germany

Iran University of Medical Sciences Tehran Iran

Istanbul University Istanbul Faculty of Medicine Istanbul Turkey

Jagellonian University Medical College Kraków Poland

Lucile Packard Children's Hospital at Stanford Palo Alto USA

Medical University of Gdansk Department of Pediatrics Nephrology and Hypertension Gdańsk Poland

Nationwide Children's Hospital Columbus OH USA

Nemours A 1 duPont Hospital for Children Wilmington DE USA

NRS Medical College and Hospital Kolkata India

Pediatric nephrology Dialysis and Transplantation Unit Fondazione IRCCS Ca' Granda Osp Maggiore Policlinico Milan Italy

S E N N 1 A D Montevideo Uruguay

Seattle Children's Hospital Seattle WA USA

Semmelweis University Budapest Hungary

Service de Néphrologie Pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Lyon France

University Hospital Motol Prague Czech Republic

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