Role of Quadriceps Muscle Ultrasound in Nutritional Assessment of Children on Maintenance Hemodialysis: A Tertiary Center Study

Background: Protein-energy wasting (PEW) is highly prevalent among children receiving maintenance hemodialysis, yet accurate and objective assessment of nutritional status remains challenging. Muscle mass assessment is one of the diagnostic tools for malnutrition according to current definitions, and muscle ultrasound (US) can be used for the diagnosis and monitoring of malnutrition. Methods: A tertiary hemodialysis center case–control study enrolled 42 children on hemodialysis (age range: 1–16 years) and 42 age- and sex-matched apparently healthy children as a control group. Demographic, anthropometric, clinical, and laboratory information were gathered. A dietary evaluation using a 3-day food intake record was performed to assess protein adequacy. The thickness of the quadriceps muscle, primarily the rectus femoris, the largest skeletal muscle in the body, was assessed using B-mode muscle US in both groups. Results: Children on hemodialysis had significantly lower caloric and protein intake compared with controls (both p < 0.001) and 40.5% of patients had inadequate protein intake. Children on maintenance hemodialysis had significantly reduced peripheral muscle thickness compared with healthy controls. Correlation analysis showed that total caloric and protein intake were positively associated with muscle thickness (p < 0.001). The ROC curve showed that among muscle parameters, rectus femoris thickness ≤10.4 mm demonstrated excellent sensitivity (100%) but moderate specificity (48%), with an AUC of 0.731 (p < 0.001).While anthropometric and dietary measures identified malnutrition in 21–43% of patients, ultrasound-based muscle mass classified approximately half of cases had low muscle mass, suggesting a higher sensitivity for detecting nutritional impairment Conclusion: Quadriceps muscle ultrasonography is a simple, non-invasive bedside tool that may aid in screening and monitoring PEW in children on maintenance hemodialysis.