Protein-energy wasting (PEW) a condition of decreased body protein and fat mass is highly prevalent in chronic kidney disease (CKD) patients and a potent predictor of mortality in this population. condition using a combination of biochemical markers clinical measurements and subjective reporting in children in the CKiD cohort: 1) minimal PEW definition (��2 adult-defined PEW criteria); 2) standard PEW definition (��3 adult-defined PEW criteria); and 3) modified PEW definition (��3 adult-defined PEW criteria plus short stature or poor growth). The authors observed that getting together with the modified PEW definition was associated with a significantly increased risk of hospitalization in unadjusted analyses ie 2.2-fold higher risk and trended towards increased risk in multivariable adjusted analyses ie 2.0-fold higher risk. At this time future studies validating these findings and developing further refined definitions and/or scoring systems for the detection and management of PEW in children and uremic failure to TG100-115 thrive are urgently needed. [5]. A recent study published in entitled ��Protein energy wasting in children with chronic kidney disease�� [5] has sought to combine biochemical markers clinical measurements and subjective reporting of children in the CKiD cohort into a clinically significant scoring system for PEW in children. The criteria for PEW included: 1) biochemical parameters (total cholesterol TG100-115 <100 mg/100 mL serum albumin <3.8 mg/dL transferrin <140 mg/dL and C-reactive protein <3 mg/L) 2 reduced body mass (BMI for height-age <5th percentile at entry or decrease in BMI for height-age and sex >10% between 1st and 2nd TG100-115 annual measurements) 3 reduced muscle mass (mid-upper arm circumference [MUAC] for height-age and sex <5th percentile or a decrease in MUAC for height-age and sex percentile >10% between 1st and 2nd annual visits) and 4) decreased appetite as surrogate for dietary protein intake reported as fair poor or very poor over the week prior to study visit [5]. The scoring system was defined as ��minimal PEW�� (��2 categories) ��standard PEW�� (��3 categories) and ��modified PEW�� (��3 categories and poor growth defined as: height for age and sex percentile <3rd percentile or poor growth velocity or decrease in height for age greater than 10% between 1st and 2nd annual visits). The major outcome evaluated was incidence of hospitalization over a two-year follow-up period. The authors found a modest association between the modified PEW definition and risk of hospitalization in unadjusted analyses (ie 2.2-fold higher risk unadjusted p value=0.03) although it did not reach statistical significance in analyses adjusted for confounders (ie 2.0-fold higher risk adjusted p value=0.06) [5]. An important contribution made by this study is the expansion of the definition CD68 of PEW to include growth/growth velocity in children [5]. Without the addition of growth/growth velocity to the scoring system (ie the distinction between standard PEW and modified PEW) there would be no TG100-115 statistically significant correlation between PEW and hospitalization risk even in the unadjusted analyses. Although the adjusted analyses did not find a statistically significant association between modified PEW and hospitalization risk there may be many explanations for this which are outlined below [5]. We believe that refined definitions TG100-115 and/or scoring systems for PEW in children and uremic failure to thrive are urgently needed and would serve as a better predictor of clinical outcome specifically in children with CKD in lieu of criteria used to diagnose PEW in adults with CKD. For example in evaluating the author��s criteria for PEW based on the CKiD cohort utilized total cholesterol and transferrin values were the biochemical parameters that showed minimal to no significance in the evaluation of PEW. One could argue that these two values may be forgotten and other markers may be adopted from the adult literature that prove to be of greater significance (eg pre-albumin IGF-1 etc). It is likely however that these other values were not assessed in the CKiD cohort and for that reason the authors were limited in their evaluation of PEW based on the parameters which were tested. Also in evaluating Table 1.