The consequences of chronic kidney disease on bone metabolism and growth in children

Bacchetta, Justine; Harambat, Jérôme; Cochat, Pierre; Salusky, Isidro B.; Wesseling‐Perry, Katherine

doi:10.1093/ndt/gfs299

Cited by 97 publications

(62 citation statements)

References 95 publications

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“…Moreover, height at start of RRT increased by 0.4 SDS from the early period to the more recent years of starting RRT. This would suggest that the observed moderate improvement of final height over time was mainly due to better growth management during the pre-ESRD period and that any strategies to prevent or correct CKD-associated growth failure (31)(32)(33)(34) are most likely to be effective before ESRD has occurred. However, when we analyzed only patients with a greater "growth potential" on RRT, namely only the patients ,16 years of age at start of RRT, the change between height at start and final height measurement significantly improved over time ( Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Harambat¹,

Bonthuis²,

Stralen

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Growth and final height are of major concern in children with ESRD. This study sought to describe the distribution of adult height of patients who started renal replacement therapy (RRT) during childhood and to identify determinants of final height in a large cohort of RRT children.Design, setting, participants, & measurements A total of 1612 patients from 20 European countries who started RRT before 19 years of age and reached final height between 1990 and 2011 were included. Linear regression analyses were performed to calculate adjusted mean final height SD score (SDS) and to investigate its potential determinants.Results The median final height SDS was 21.65 (median of 168 cm in boys and 155 cm in girls). Fifty-five percent of patients attained an adult height within the normal range. Adjusted for age at start of RRT and primary renal diseases, final height increased significantly over time from 22.06 SDS in children who reached adulthood in 1990-1995 to 21.33 SDS among those reaching adulthood in 2006-2011. Older age at start of RRT, more recent period of start of RRT, cumulative percentage time on a functioning graft, and greater height SDS at initiation of RRT were independently associated with a higher final height SDS. Patients with congenital anomalies of the kidney and urinary tract and metabolic disorders had a lower final height than those with other primary renal diseases.Conclusions Although final height remains suboptimal in children with ESRD, it has consistently improved over time.

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Section: Discussionmentioning

confidence: 99%

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Harambat¹,

Bonthuis²,

Stralen

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Growth impairment is a unique manifestation of pediatric CKD with major implications for quality of life, morbidity, and mortality during childhood and beyond (4,6,7). Despite the ability to modify many of the factors that contribute to growth delay, outcome studies demonstrate that optimal adult height is often not achieved in patients diagnosed with CKD during childhood (23,28). Thus, investigation of under-recognized risk factors for growth delay in pediatric CKD is critically important.…”

Section: Discussionmentioning

confidence: 99%

“…It has been proposed that CKD mineral and bone disorder, acidosis, anemia, vitamin D deficiency, and rhGH resistance all have a deleterious effect on the growth velocity of children with CKD (22,23). Thus, one would expect that adherence to any class of medication aimed to control these relevant CKD comorbidities (i.e., phosphate [PO4] binders, active vitamin D, nutritional vitamin D, alkali, iron, erythrocytestimulating agents [ESAs], and rhGH) might improve growth; conversely, nonadherence to any of these medications could impair growth.…”

Section: Introductionmentioning

confidence: 99%

Medication Adherence and Growth in Children with CKD

Akchurin¹,

Schneider²,

Mulqueen³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD.Design, setting, participants, & measurements The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age-and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations.Results Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height#3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score.Conclusions Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and improved patient outcome.

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“…Maintaining normal mineral levels is important to not only ensure adequate linear growth (2) but to also avoid cardiovascular complications (3).…”

Section: Introductionmentioning

confidence: 99%

Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal AssociationEuropean Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant recipients.Design, setting, participants, & measurements This study included 1237 children (0-17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure.Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR.Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction.

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The consequences of chronic kidney disease on bone metabolism and growth in children

Cited by 97 publications

References 95 publications

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Medication Adherence and Growth in Children with CKD

Mineral Metabolism in European Children Living with a Renal Transplant

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