Height at First RRT and Mortality in Children

Ku, Elaine; Fine, Richard Ν.; Hsu, Chi-yuan; McCulloch, Charles E.; Glidden, David V.; Grimes, Barbara; Johansen, Kirsten L.

doi:10.2215/cjn.08250815

Cited by 35 publications

(24 citation statements)

References 19 publications

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“…A report from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) echoed these results, demonstrating that mortality risk was twice as high in children with a height SDS <2.5 compared with those of normal height [ 54 ]. Both short (<3rd percentile) and tall (>3rd percentile) stature at RRT initiation were associated with an increased risk of death, although tall stature was seen only in a small group of white children with elevated BMI (>95th percentile) [ 55 ].…”

Section: Factors Associated With Mortalitymentioning

confidence: 99%

Survival in children requiring chronic renal replacement therapy

et al. 2017

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Survival in the pediatric end-stage renal disease (ESRD) population has improved substantially over recent decades. Nonetheless, mortality remains at least 30 times higher than that of healthy peers. Patient survival is multifactorial and dependent on various patient and treatment characteristics and degree of economic welfare of the country in which a patient is treated. In this educational review, we aim to delineate current evidence regarding mortality risk in the pediatric ESRD population and provide pediatric nephrologists with up-to-date information required to counsel affected families.

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Section: Factors Associated With Mortalitymentioning

confidence: 99%

Survival in children requiring chronic renal replacement therapy

et al. 2017

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“…Duration of dialysis before transplant, year 0.9 (0.6) 0.9 (1.0 Mid-parental height, cm 171 (6) 170 (5) .28…”

Section: Chronic Kidney Disease Characteristicsmentioning

confidence: 99%

“…Growth failure is associated with increased mortality, hospitalizations and infections [3,4] after kidney transplantation. A recent retrospective analysis of 2008 children after their first kidney transplantation in the United States Renal Data System (USRDS) database documented a higher risk of all-cause mortality, as well as cardiac-and infection-related death in patients who had short stature [5]. The relationship between short stature prior to transplant and post-transplant kidney function, however, has not been well characterized in previous literature.…”

Section: Introductionmentioning

confidence: 99%

Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant

Greenbaum

Warady

et al. 2019

Pediatr Nephrol

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Background-Among children who receive a kidney transplant, short stature is associated with a more complicated post-transplant course and increased mortality. Short stature prior to transplant may reflect the accumulated risk of multiple factors during chronic kidney disease (CKD); however, its relationship with post-transplant kidney function has not been well characterized. Methods-In the Chronic Kidney Disease in Children (CKiD) cohort restricted to children who received a kidney transplant, short stature (i.e., growth failure) was defined as age-sex-specific height <3 rd percentile. The outcome was time to estimated glomerular filtration rate (eGFR) <45ml/min/1.73m 2 after transplant. Parametric survival models, including adjustment for disease severity, socioeconomic status (SES), and parental height by inverse probability weighting, described the relative times to eGFR<45ml/min/1.73m 2. Results-Of 138 children (median CKD duration at transplant: 13 years), 20% (28) had short stature before the transplant. The median time to eGFR<45ml/min/1.73m 2 after kidney transplantation was 6.6 years and those with short stature had a significantly faster time to the poor outcome (log-rank p-value: 0.004). Children with short stature tended to have lower SES, nephrotic proteinuria, higher blood pressure and lower mid-parental height before transplant. After adjusting for these variables, children with growth failure had 40% shorter time to eGFR<45ml/min/1.73m 2 than those with normal stature (relative time: 0.60, 95%CI: 0.32,1.03). Conclusions-Short stature was associated with a faster time to low kidney function after transplant. SES, disease severity and parental height partially explained the association. Clinicians should be aware of the implications of growth failure on the outcome of this unique population, while continued attempts are made to define modifiable factors that contribute to this association.

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“…The risk of severe growth retardation is the higher the younger the child is, which places an additional burden on patients and hampers their psychosocial integration (9). In addition, short stature is associated with markedly enhanced mortality, supporting the concept that normal longitudinal growth is a sensitive indicator of overall well-being in these patients (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

Haffner

2020

Front. Pediatr.

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Growth failure is a hallmark in children with chronic kidney disease (CKD). Therefore, early diagnosis and adequate management of growth failure is of utmost importance in these patients. The risk of severe growth retardation is the higher the younger the child is, which places an additional burden on patients and their families and hampers the psychosocial integration of these children. Careful monitoring of growth, and effective interventions are mandatory to prevent and treat growth failure in children with CKD at all ages and all stages of kidney failure. Early intervention is critical, as all therapeutic interventions are much more effective if they are started prior to the initiation of dialysis. Prevention and treatment of growth failure focuses on: (i) preservation of renal function, e.g., normalization of blood pressure and proteinuria by use of inhibitors of the renin-angiotensin aldosterone system, (ii) adequate energy intake, including tube feeding or gastrostomy in case of persisting malnutrition, (iii) substitution of water and electrolytes, especially in children with renal malformation, (iv) correction of metabolic acidosis, (v) control of parathyroid hormone levels within the CKD-dependent target range, (vi) use of recombinant human growth hormone in cases of persistent growth failure, and, (vii) early/preemptive kidney transplantation using steroid-minimizing immunosuppressive protocols in children with end-stage CKD. This review discusses these measures based on recent guidelines.

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Height at First RRT and Mortality in Children

Cited by 35 publications

References 19 publications

Survival in children requiring chronic renal replacement therapy

Survival in children requiring chronic renal replacement therapy

Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

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