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Growth and PTH in prepubertal children on long-term dialysis
Janette Cansick1, Simon Waller, Deborah Ridout
1Department of Nephrology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK. jcansick@doctors.org.uk
Insights
Growth failure in children on dialysis is common, but maintaining good nutrition and phosphorus control can prevent further height loss. Younger children (<2 years) may experience catch-up growth during their first year of dialysis.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Renal Osteodystrophy
Background:
- Growth failure is a significant complication for pediatric patients undergoing dialysis.
- Renal bone disease is a potential contributing factor to impaired growth in these children.
- Understanding growth patterns and influencing factors is crucial for managing children on dialysis.
Purpose of the Study:
- To analyze growth patterns in children on dialysis.
- To investigate the relationship between parathyroid hormone (PTH), calcium, and phosphate levels and growth in pediatric dialysis patients.
- To identify strategies for optimizing growth in children with kidney disease.
Main Methods:
- Retrospective review of case notes for 35 children on dialysis.
- Data collected included age, dialysis duration, height standard deviation score (HtSDS), PTH, calcium, and phosphate levels.
- Follow-up data collected until age 10 years, growth hormone initiation, or renal transplantation.
Main Results:
- The mean HtSDS at the start of dialysis was -2.06; no significant change in HtSDS per year was observed overall.
- Children under 2 years old showed catch-up growth in their first year on dialysis (median HtSDS change of 0.31).
- PTH levels were elevated (median 1.52 times the upper limit of normal) but did not correlate with growth; calcium and phosphate levels were within or slightly above normal ranges.
Conclusions:
- Intensive nutritional therapy and phosphorus control are vital to maintain PTH levels within the normal range and prevent further height loss in children on dialysis.
- Early intervention and management, particularly in younger children (<2 years), may facilitate catch-up growth during the initial year of dialysis.
Abstract:
Growth failure is an important complication for children on dialysis. One possible influence on growth is renal bone disease. We reviewed the case notes of 35 children (23 boys), mean (range) age at inclusion 2.8 (0.25-8.9) years (17 children age <2 years), on dialysis for 2.0 (1-4.8) years, for growth, PTH, calcium and phosphate levels and medications. Data collection ended at age 10 years, commencement of growth hormone (rhGH) or renal transplantation. The mean (range) height standard deviation score (HtSDS) at the start of dialysis was -2.06 (-5.90 to 0.63). No change in HtSDS per year was observed; the median was -0.06 (-1.07 to 2.39). Children aged <2 years showed catch-up growth in the first year on dialysis; median change in HtSDS was 0.31 (-0.78 to 3.13). Mean plasma calcium and ionised calcium were approximately at the mid-point and phosphate just above the mid-point of the respective normal ranges. The median PTH level was 1.52 times the upper limit of normal and levels did not correlate with growth. Our results indicate that intensive nutritional therapy and phosphorus control aiming to keep PTH within the normal range prevents further loss of HtSDS in short children on dialysis. In some children under 2 years of age catch-up growth can be observed in the first dialysis year.
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