Associations of longitudinal height and weight with clinical outcomes in pediatric kidney replacement therapy: results from the ESPN/ERA Registry

Abstract

Background Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT. Methods We included patients < 20 years starting KRT in 33 European countries from 1995–2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) < –1.88 and tall stature as height SDS > 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates. Results We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78–0.86), tall (aHR: 0.65, 95% CI: 0.56–0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71–0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92–2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38–2.23) and obese (aHR: 1.49, 95% CI: 1.11–1.99) patients showed higher all-cause mortality risk than normal weight subjects. Conclusions Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. Graphical abstract

Predicting wait time for pediatric kidney transplant: a novel index

“…Anthropometric variables BMI-for-age and height-for-age were also not found to be significant predictors of likelihood to transplantation. These variables are likely to be impacted by disease severity as kidney failure has a well-known effect on bone mineralization and vertical growth [ 32 – 34 ]. Given the heterogeneity of kidney failure etiology and age of disease presentation, these growth parameters may be a poor predictor of wait time, as shown in our study.…”

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

“…Research on the clinical rami cations of PEW in pediatric CKD remains scarce [9,14,37]. The primary hurdle stems from the absence of universally validated criteria for diagnosing PEW in children.…”

“…The CKiD study highlighted the importance of growth in predicting the risk for hospitalisations in children with CKD stages2-4 [9]. Recent data in children on kidney replacement therapies from the European Society of Pediatric Nephrology/ European Renal Association registry revealed higher mortality risk in those with short stature and undernutrition with infections contributing to death in the majority [14].…”