Growth failure, risk of hospitalization and death for children with end-stage renal disease

Abstract

Growth failure remains a significant problem for children with chronic renal insufficiency and end-stage renal disease (ESRD). We examined whether growth failure is associated with more-frequent hospitalizations or higher mortality in children with kidney disease. We studied data on prevalent United States pediatric patients with ESRD in 1990 who were followed through 1995. Patients were categorized according to the standard deviation score (SDS) of their incremental growth during 1990: severe (<-3 SDS), moderate growth failure (>-3 and <-2 SDS), and normal growth (>-2 SDS). Among 1,112 prevalent pediatric dialysis and transplant patients (<17 years, Tanner I-IV), those with severe and moderate growth failure had higher hospitalization rates [relative risk (RR) 1.14 [95% confidence interval (CI) 1.1, 1.2] and 1.24 [95% CI 1.2, 1.3]] respectively than those with normal growth after adjustment for age, gender, race, cause and duration of ESRD, and treatment modality (dialysis or transplant) in 1990. Kaplan-Meier survival analysis showed 5-year survival of 85% and 90% for patients with severe and moderate growth failure, respectively, compared with 96% for patients with normal growth ( P<0.001, log-rank). Cox proportional hazards analysis revealed that those with severe (RR 2.9, 95% CI 1.6, 5.3) and moderate growth failure (RR 2.01, 95% CI 1.1, 3.6) had an increased risk of death compared with youths with normal growth, after adjustment. A higher proportion of deaths in the severe and moderate growth failure groups were attributed to infectious causes (22% and 18.7%, respectively) than in the normal growth group (15.6%). We conclude that growth failure is associated with a more-complicated clinical course and increased risk of death for children with kidney failure.

Height at First RRT and Mortality in Children

“…* Hazard ratio is the hazard ratio for a given height z-score, divided by the baseline hazard. association between short stature and higher risk of death that has previously been reported in both a prevalent USRDS cohort of children with ESRD followed between 1990 and 1995 and an incident cohort of children initiated on RRT before 2000 in a voluntary North American registry (2,3,13). The elevated risk of death in the pediatric population with short stature may, in part, reflect illness severity or diminished access to nephrology care and is not entirely unexpected.…”

“…A higher risk of infectious complications is not unexpected because short stature may track with poor nutritional status, which may predispose children receiving RRT to infections (2,22). However, the reasons why short stature in children with kidney disease is associated with a higher risk of cardiac death are not entirely clear.…”

Sevelamer carbonate increases serum bicarbonate in pediatric dialysis patients

“…The increase and normalization of serum bicarbonate levels after the switch to sevelamer carbonate is of particular importance in children with CKD in whom growth retardation remains a significant problem [14,15]. It is well recognized that children with chronic metabolic acidosis and normal renal function have poor growth, and in vitro studies have shown that metabolic acidosis is associated with a decrease in bone mineralization [16].…”

Nutritional Status in Children with Chronic Renal Failure on Hemodialysis

“…Growth failure is a common and significant clinical problem in children with chronic renal failure. Affected children exhibit a range of potentially serious medical and psychological complications, as well as increased mortality [7]. The most common causes of hospitalization in these patients are infections, possibly related to their poor nutritional status.…”