Underweight, overweight and obesity in paediatric dialysis and renal transplant patients

Nephrol Dial Transplant. 2013 Nov;28 Suppl 4:iv195-iv204. doi: 10.1093/ndt/gft259. Epub 2013 Aug 23.


Background: The prevalence of childhood overweight is rising worldwide, but in children on renal replacement therapy (RRT) a poor nutritional status is still the primary concern. We aimed to study the prevalence of, and factors associated with, underweight and overweight/obesity in the European paediatric RRT population. Moreover, we assessed the evolution of body mass index (BMI) after the start of RRT.

Methods: We included 4474 patients younger than 16 years from 25 countries of whom BMI data, obtained between 1995 and 2010, were available within the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Prevalence estimates for under- and overweight/obesity were calculated using age and sex-specific criteria of the World Health Organization (WHO, 0-1 year olds) and the International Obesity Task Force cut-offs (2-15 year olds).

Results: The prevalence of underweight was 3.5%, whereas 20.8% of the patients were overweight and 12.5% obese. Factors associated with being underweight were receiving dialysis treatment and infant age. Among transplanted recipients, a very short stature (OR: 1.64, 95% CI: 1.40-1.92) and glucocorticoid treatment (OR: 1.23, 95% CI: 1.03-1.47) were associated with a higher risk of being overweight/obese. BMI increased post-transplant, and a lower BMI and a higher age at the start of RRT were associated with greater BMI changes during RRT treatment.

Conclusions: Overweight and obesity, rather than underweight, are highly prevalent in European children on RRT. Short stature among graft recipients had a strong association with overweight, while underweight appears to be only a problem in infants. Our findings suggest that nutritional management in children receiving RRT should focus as much on the prevention and treatment of overweight as on preventing malnutrition.

Keywords: children; nutritional status; overweight; renal replacement therapy; underweight.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Body Mass Index
  • Child
  • Child, Preschool
  • Female
  • France / epidemiology
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation*
  • Male
  • Nutritional Status
  • Obesity / epidemiology*
  • Obesity / physiopathology
  • Overweight / epidemiology*
  • Overweight / physiopathology
  • Prevalence
  • Renal Dialysis*
  • Risk Factors
  • Thinness / epidemiology*
  • Thinness / physiopathology