Association of Chronic Kidney Disease with Muscle Deficits in Children

Abstract

The effect of chronic kidney disease (CKD) on muscle mass in children, independent of poor growth and delayed maturation, is not well understood. We sought to characterize whole body and regional lean mass (LM) and fat mass (FM) in children and adolescents with CKD and to identify correlates of LM deficits in CKD. We estimated LM and FM from dual energy x-ray absorptiometry scans in 143 children with CKD and 958 controls at two pediatric centers. We expressed whole body, trunk, and leg values of LM and FM as Z-scores relative to height, sitting height, and leg length, respectively, using the controls as the reference. We used multivariable regression models to compare Z-scores in CKD and controls, adjusted for age and maturation, and to identify correlates of LM Z-scores in CKD. Greater CKD severity associated with greater leg LM deficits. Compared with controls, leg LM Z-scores were similar in CKD stages 2 to 3 (difference: 0.02 [95% CI: Ϫ0.20, 0.24]; P ϭ 0.8), but were lower in CKD stages 4 to 5 (Ϫ0.41 [Ϫ0.66, Ϫ0.15]; P ϭ 0.002) and dialysis (Ϫ1.03 [Ϫ1.33, Ϫ0.74]; P Ͻ 0.0001). Among CKD participants, growth hormone therapy associated with greater leg LM Z-score (0.58 [0.03, 1.13]; P ϭ 0.04), adjusted for CKD severity. Serum albumin, bicarbonate, and markers of inflammation did not associate with LM Z-scores. CKD associated with greater trunk LM and FM, variable whole body LM, and normal leg FM, compared with controls. In conclusion, advanced CKD associates with significant deficits in leg lean mass, indicating skeletal muscle wasting. These data call for prospective studies of interventions to improve muscle mass among children with CKD.

Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study

“…Consistent with previous studies, our results demonstrate the level of estimated renal function to be an important independent variable correlating with growth outcomes in children with CKD [18, 24, 25]. What has not previously been published is our finding that for each 10/mL/min/1.73m 2 decrease in GFR, there was an average decrease of 0.14 SDS in height for the overall cohort (and an average decrease of 0.12 SDS after excluding those who were prescribed rhGH); the quantification of this association will be further studied longitudinally in the CKiD cohort.…”

“…The data obtained from our large patient cohort did not reveal an association between anemia and poor growth, largely negating any further consideration of any such correlation in patients with only mild anemia. Consistent with other reports, multivariate analysis of serum albumin, phosphate, and CRP also revealed no association with baseline growth outcomes in the CKiD cohort [3, 18, 24]…”

Influence of Chronic Kidney Disease on Physical Function and Quality of Life in Patients after Coronary Artery Bypass Grafting

“…Therefore, we further analyzed the leg fat percentages of the CKD subpopulation with NYHA class I-II heart failure as compared with their BMI-matched controls, excluding the CKD subjects with NYHA class III heart failure, and a difference no longer existed (p = 0.076). This result is in agreement with that of a previous report by Foster et al [18]. The authors compared whole body and regional LBM and fat mass in children and adolescents with CKD and those without.…”

Changes in bone structure and the muscle–bone unit in children with chronic kidney disease

“…1, 2, 38-40 Patients were ineligible for this study if they had a history of chronic conditions unrelated to CKD that may impact bone health or had a functioning renal allograft.…”