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Growth failure, risk of hospitalization and death for children with end-stage renal disease
Susan L Furth1, Wenke Hwang, Ching Yang
1Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. sfurth@jhmi.edu
Insights
Growth failure in children with kidney disease significantly increases hospitalization and mortality risks. Early identification and intervention are crucial for improving outcomes in pediatric end-stage renal disease patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Kidney Disease
Background:
- Growth failure is a prevalent complication in children with chronic renal insufficiency and end-stage renal disease (ESRD).
- The clinical significance of growth failure in pediatric ESRD patients, particularly concerning hospitalization and mortality, requires further investigation.
Purpose of the Study:
- To determine the association between growth failure and hospitalization rates in pediatric patients with end-stage renal disease (ESRD).
- To assess the impact of growth failure on long-term survival in children with kidney failure.
- To analyze the causes of death in relation to growth failure severity in pediatric ESRD.
Main Methods:
- Retrospective cohort study of 1,112 prevalent US pediatric ESRD patients (dialysis and transplant) from 1990-1995.
- Patients categorized by growth failure severity (severe, moderate, normal) using standard deviation scores (SDS).
- Statistical analyses included relative risk, Kaplan-Meier survival analysis, and Cox proportional hazards modeling.
Main Results:
- Patients with severe and moderate growth failure exhibited significantly higher hospitalization rates compared to those with normal growth.
- Five-year survival rates were lower for children with severe (85%) and moderate (90%) growth failure versus normal growth (96%).
- Severe and moderate growth failure were independently associated with increased mortality risk (RR 2.9 and 2.01, respectively).
- Infectious causes of death were more frequent in children with growth failure.
Conclusions:
- Growth failure in pediatric ESRD is linked to a more complex clinical course, characterized by increased hospitalizations and a higher risk of mortality.
- These findings underscore the importance of monitoring and addressing growth in children with kidney failure to improve their overall prognosis.
- Infectious complications may play a significant role in the increased mortality observed in this vulnerable population.
Abstract:
Growth failure remains a significant problem for children with chronic renal insufficiency and end-stage renal disease (ESRD). We examined whether growth failure is associated with more-frequent hospitalizations or higher mortality in children with kidney disease. We studied data on prevalent United States pediatric patients with ESRD in 1990 who were followed through 1995. Patients were categorized according to the standard deviation score (SDS) of their incremental growth during 1990: severe (<-3 SDS), moderate growth failure (>-3 and <-2 SDS), and normal growth (>-2 SDS). Among 1,112 prevalent pediatric dialysis and transplant patients (<17 years, Tanner I-IV), those with severe and moderate growth failure had higher hospitalization rates [relative risk (RR) 1.14 [95% confidence interval (CI) 1.1, 1.2] and 1.24 [95% CI 1.2, 1.3]] respectively than those with normal growth after adjustment for age, gender, race, cause and duration of ESRD, and treatment modality (dialysis or transplant) in 1990. Kaplan-Meier survival analysis showed 5-year survival of 85% and 90% for patients with severe and moderate growth failure, respectively, compared with 96% for patients with normal growth ( P<0.001, log-rank). Cox proportional hazards analysis revealed that those with severe (RR 2.9, 95% CI 1.6, 5.3) and moderate growth failure (RR 2.01, 95% CI 1.1, 3.6) had an increased risk of death compared with youths with normal growth, after adjustment. A higher proportion of deaths in the severe and moderate growth failure groups were attributed to infectious causes (22% and 18.7%, respectively) than in the normal growth group (15.6%). We conclude that growth failure is associated with a more-complicated clinical course and increased risk of death for children with kidney failure.
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