Integrated Prediction and Management of Protein Energy Wasting in Pediatric Chronic Kidney Disease: A Prospective Cohort Study at The Children's National Medical Center

Background: Protein‑energy wasting (PEW) is a multifactorial complication in children with chronic kidney disease (CKD), leading to growth failure, poor quality of life, and increased mortality. However, routine nutritional assessment often lacks predictive tools and integrated management strategies. Objective: To develop a predictive model for nutritional deterioration in children with CKD stages 3‑5D and to evaluate the efficacy of a targeted, multi‑component nutritional intervention protocol at the Children's National Medical Center. Methods: A prospective cohort study (January 2022 – December 2025) enrolled 154 children with CKD (7‑17 years, stages 3‑5D). Comprehensive assessment included anthropometry, bioelectrical impedance analysis (BIA), dietary records, and serum biomarkers. A multivariate logistic regression model was developed to predict weight‑for‑height decline (≥0.5 SD over 12 months). High-risk patients (n=72) were allocated to either the intervention or standard care group based on consent and logistical feasibility.” to a 12‑month intensive Nutritional Optimization Protocol (NOP) or standard care. Results: “The baseline prevalence of PEW was 38.3%.” The final predictive model included dialysis vintage >12 months (OR=4.21), low phase angle (PhA<5°) (OR=3.84), energy intake <80% (OR=3.52), low leptin (OR=2.93), and frequent hospitalizations (OR=2.71); AUC‑ROC=0.89. After 12 months, the NOP group showed significant improvements vs. controls: weight‑for‑height Z‑score (+0.42 vs. −0.11, p<0.001), mid‑upper arm circumference (+1.8 vs. +0.3 cm, p<0.001), serum albumin (+0.35 vs. +0.05 g/dL, p=0.003), and a 32% reduction in hospitalization days. Phase angle <4.5° predicted low prealbumin with 85% sensitivity and 78% specificity. Conclusion: A validated predictive model using clinical, dietary, and BIA parameters enables early identification of children at risk for PEW. A multi‑modal, individualized nutritional intervention significantly improves nutritional status and reduces hospitalizations, supporting its integration into routine care at the Children's National Medical Center

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