Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis : A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network

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.Peer reviewe

Attachment quality and psychopathological symptoms in clinically referred adolescents : the mediating role of early maladaptive schema

This study investigated relationships between attachment insecurity, maladaptive cognitive schemas, and various types of psychopathological symptoms in a sample of clinically referred adolescents (N = 82). A mediation model was tested in which maladaptive schemas operated as mediators in the relations between indices of attachment quality and conduct, peer, and emotional problems. Results revealed partial support for the hypothesized mediation effect: the schema domain of disconnection/rejection acted as a mediator in the links between insecure attachment and peer problems and emotional problems. Further analysis of these effects revealed that different types of maladaptive schemas were involved in both types of psychopathology. Altogether, findings suggest that treatment of adolescent psychological problems may need to target the improvement of attachment relationships with peers and parents and the correction of underlying cognitive schemas