Assessment and management of obesity and metabolic syndrome in children with CKD stages 2–5 on dialysis and after kidney transplantation—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Stella Stabouli, Nonnie Polderman, Christina L. Nelms, Fabio Paglialonga, Michiel J. S. Oosterveld, Larry A. Greenbaum, Bradley A. Warady, Caroline Anderson, Dieter Haffner, An Desloovere, Leila Qizalbash, José Renken-Terhaerdt, Jetta Tuokkola, Johan Vande Walle, Vanessa Shaw, Mark Mitsnefes, Rukshana Shroff

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Obesity and metabolic syndrome (O&MS) due to the worldwide obesity epidemic affects children at all stages of chronic kidney disease (CKD) including dialysis and after kidney transplantation. The presence of O&MS in the pediatric CKD population may augment the already increased cardiovascular risk and contribute to the loss of kidney function. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. We present CPRs for the assessment and management of O&MS in children with CKD stages 2–5, on dialysis and after kidney transplantation. We address the risk factors and diagnostic criteria for O&MS and discuss their management focusing on non-pharmacological treatment management, including diet, physical activity, and behavior modification in the context of age and CKD stage. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.
Original languageEnglish
JournalPediatric nephrology (Berlin, Germany)
Issue number1
Early online date2021
Publication statusPublished - Jan 2022


  • Chronic kidney disease
  • Clinical practice recommendations
  • Diet
  • Kidney transplantation
  • Metabolic syndrome
  • Obesity
  • Pediatric Renal Nutrition Taskforce
  • Physical activity
  • Screen time
  • Sleep

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