Kidney transplantation fails to provide adequate growth in children with chronic kidney disease born small for gestational age

Franke, Doris; Steffens, Rena; Thomas, Lena; Pavičić, Leo; Ahlenstiel, Thurid; Pape, Lars; Gellermann, Jutta; Müller, Dominik N.; Querfeld, Uwe; Haffner, Dieter; Živičnjak, Miroslav

doi:10.1007/s00467-016-3503-5

Cited by 11 publications

(14 citation statements)

References 29 publications

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“…Treatment with recombinant human growth hormone (rhGH) is a measure proven to improve adult height in short children with CKD ( 13 ). The positive results from initial clinical trials have been confirmed by several large, prospective, observational studies and registries, underlining the importance of its use in this population in order to improve growth outcome ( 19 , 37 – 41 ). Clinical practice recommendations for the use of rhGH in pediatric CKD patients have been provided by expert committees ( 13 , 42 ).…”

Section: Prevention and Treatmentmentioning

confidence: 87%

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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Section: Prevention and Treatmentmentioning

confidence: 87%

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

Haffner

2020

Front. Pediatr.

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“…From May 1998 until November 2019, a total of 947 children with CKD stages 3–5D and after KT were enrolled in the CKD Growth and Development Study, which is a prospective, observational cohort study performed at two pediatric nephrology centers in Germany (Hannover Medical School and Charité Universitätsmedizin Berlin). Patients are followed up at yearly intervals for clinical, biochemical and anthropometric assessment as previously described [ 19 ]. The study was approved by the local ethics committees, and research was performed in accordance with the declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…Whether the type of transplantation (living versus deceased donor; pre-emptive KT versus prior dialysis) or treatment with recombinant human growth hormone (GH) prior to KT impact on post-transplant growth are largely unknown [ 5 , 10 , 15 ]. Previous analyses mainly coming from patient registries did not include detailed data on factors affecting growth, such as abnormal birth history, low parental height, pubertal status, and medication use (i.e., steroids, GH) and could therefore not adjust for these variables [ 13 , 16 – 19 ]. Finally, CKD 5 in children is associated with more severe impairment of leg growth in comparison to trunk growth resulting in disproportionate short stature [ 13 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous analyses mainly coming from patient registries did not include detailed data on factors affecting growth, such as abnormal birth history, low parental height, pubertal status, and medication use (i.e., steroids, GH) and could therefore not adjust for these variables [ 13 , 16 – 19 ]. Finally, CKD 5 in children is associated with more severe impairment of leg growth in comparison to trunk growth resulting in disproportionate short stature [ 13 , 19 , 20 ]. We hypothesized that KT stimulates the growth of linear body segments (trunk and legs) differentially in toddlers and older children and that its effects on body proportions are therefore age dependent.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of growth after kidney transplantation in prepubertal children

et al. 2021

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Background Short stature is a frequent complication after pediatric kidney transplantation (KT). Whether the type of transplantation and prior treatment with recombinant human growth hormone (GH) affects post-transplant growth, is unclear. Methods Body height, leg length, sitting height, and sitting height index (as a measure of body proportions) were prospectively investigated in 148 prepubertal patients enrolled in the CKD Growth and Development study with a median follow-up of 5.0 years. We used linear mixed-effects models to identify predictors for body dimensions. Results Pre-transplant Z scores for height (− 2.18), sitting height (− 1.37), and leg length (− 2.30) were reduced, and sitting height index (1.59) was increased compared to healthy children, indicating disproportionate short stature. Catch-up growth in children aged less than 4 years was mainly due to stimulated trunk length, and in older children to improved leg length, resulting in normalization of body height and proportions before puberty in the majority of patients. Use of GH in the pre-transplant period, congenital CKD, birth parameters, parental height, time after KT, steroid exposure, and transplant function were significantly associated with growth outcome. Although, unadjusted growth data suggested superior post-transplant growth after (pre-emptive) living donor KT, this was no longer true after adjusting for the abovementioned confounders. Conclusions Catch-up growth after KT is mainly due to stimulated trunk growth in young children (< 4 years) and improved leg growth in older children. Beside transplant function, steroid exposure and use of GH in the pre-transplant period are the main potentially modifiable factors associated with better growth outcome.

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“…Birth parameters are important determinants of posttransplant growth. Children born small for gestational age (SGA) have significantly poorer growth outcome after KT compared with non-SGA patients, and their growth is more likely to be affected by other factors such as use of rhGH in the pre-transplant period, preemptive KT, and graft function [63].…”

Section: Other Factorsmentioning

confidence: 99%

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

et al. 2021

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Growth retardation is a major complication in children with chronic kidney disease (CKD) and on kidney replacement therapy (KRT). Conversely, better growth in childhood CKD is associated with an improvement in several hard morbidity–mortality endpoints. Data from pediatric international registries has demonstrated that improvements in the overall conservative management of CKD, the search for optimal dialysis, and advances in immunosuppression and kidney transplant techniques have led to a significant improvement of final height over time. Infancy still remains a critical period for adequate linear growth, and the loss of stature during the first years of life influences final height. Preliminary new original data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry confirm an association between the final height and the height attained at 2 years in children on KRT.

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Kidney transplantation fails to provide adequate growth in children with chronic kidney disease born small for gestational age

Abstract: In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients.

Cited by 11 publications

References 29 publications

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

Strategies for Optimizing Growth in Children With Chronic Kidney Disease

Determinants of growth after kidney transplantation in prepubertal children

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

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