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

Abstract

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.

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

“…In children with kidney failure, key outcomes of nutritional parameters (BMI and linear growth) include mortality, hospitalisation, infection related death, health-related quality of life, access to transplantation, graft failure, and time to reduced graft function post-transplant [32][33][34][35][36]. Extremes of BMI and growth failure have consistently been associated with adverse outcomes.…”

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

“…Kidney graft failure was higher among short and tall patients. A recent CKiD study reported that patients with short statures prior to kidney transplantation had a 40% faster progression to eGFR < 45 ml/min/1.73 m 2 post-transplant [ 13 ]. The authors speculated that mineral metabolism, chronic inflammation, and poor nutrition might contribute to poor transplant outcomes in children with growth failure [ 13 ].…”

“…A recent CKiD study reported that patients with short statures prior to kidney transplantation had a 40% faster progression to eGFR < 45 ml/min/1.73 m 2 post-transplant [ 13 ]. The authors speculated that mineral metabolism, chronic inflammation, and poor nutrition might contribute to poor transplant outcomes in children with growth failure [ 13 ]. On the other hand, it is unclear why tall children had a higher graft failure risk than children of normal height.…”

Growth in children on kidney replacement therapy: a review of data from patient registries

“…Short stature could also affect kidney graft function. In the CKiD cohort, patients with a short stature prior to transplantation had a 40% shorter time to reaching an eGFR < 45 ml/min/1.73 m 2 after KT compared to children with a normal stature, although this association was partly explained by socio-economic status, disease severity, and mid-parental height [ 20 ].…”