Growth and maturation improvement in children on renal replacement therapy over the past 20 years

Franke, Doris; Winkel, Stella; Gellermann, Jutta; Querfeld, Uwe; Pape, Lars; Ehrich, J. H. H.; Haffner, Dieter; Pavičić, Leo; Živičnjak, Miroslav

doi:10.1007/s00467-013-2502-z

Cited by 61 publications

(36 citation statements)

References 34 publications

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“…Growth after RTx is satisfactory, but the final height attained by most recipients is not their calculated target height [68,69]. The results emphasize the importance of the preoperative management of infants with ESRD or nephrosis [70]. After RTx, allograft function and steroid exposure have an impact on growth, and in those with poor growth, steroid dosing should be minimized.…”

Section: Growthmentioning

confidence: 89%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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Section: Growthmentioning

confidence: 89%

Renal transplantation in infants

2015

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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%

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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“…Even after successful kidney transplantation (KTx), catch-up growth occurs far from regularly (4,5) and is modified by age at transplantation, graft function, and steroid exposure (1)(2)(3)(4). Persistent growth failure not only hampers the psychosocial rehabilitation of patients with CKD but is strongly associated with excessive cardiovascular comorbidity (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Patterns of Growth after Kidney Transplantation among Children with ESRD

Franke

Thomas

Steffens

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Poor linear growth is a frequent complication of CKD. This study evaluated the effect of kidney transplantation on age-related growth of linear body segments in pediatric renal transplant recipients who were enrolled from May 1998 until August 2013 in the CKD Growth and Development observational cohort study.Design, setting, participants, & measurements Linear growth (height, sitting height, arm and leg lengths) was prospectively investigated during 1639 annual visits in a cohort of 389 pediatric renal transplant recipients ages 2-18 years with a median follow-up of 3.4 years (interquartile range, 1.9-5.9 years). Linear mixed-effects models were used to assess age-related changes and predictors of linear body segments.Results During early childhood, patients showed lower mean SD scores (SDS) for height (21.7) and a markedly elevated sitting height index (ratio of sitting height to total body height) compared with healthy children (1.6 SDS), indicating disproportionate stunting (each P,0.001). After early childhood a sustained increase in standardized leg length and a constant decrease in standardized sitting height were noted (each P,0.001), resulting in significant catch-up growth and almost complete normalization of sitting height index by adult age (0.4 SDS; P,0.01 versus age 2-4 years). Time after transplantation, congenital renal disease, bone maturation, steroid exposure, degree of metabolic acidosis and anemia, intrauterine growth restriction, and parental height were significant predictors of linear body dimensions and body proportions (each P,0.05). ConclusionsChildren with ESRD present with disproportionate stunting. In pediatric renal transplant recipients, a sustained increase in standardized leg length and total body height is observed from preschool until adult age, resulting in restoration of body proportions in most patients. Reduction of steroid exposure and optimal metabolic control before and after transplantation are promising measures to further improve growth outcome.

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Growth and maturation improvement in children on renal replacement therapy over the past 20 years

Abstract: Our findings demonstrate a marked improvement of growth and maturation in paediatric patients on RRT during the past 20 years.

Cited by 61 publications

References 34 publications

Renal transplantation in infants

Renal transplantation in infants

Medication Adherence and Growth in Children with CKD

Patterns of Growth after Kidney Transplantation among Children with ESRD

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