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Growth of prepubertal children on dialysis

Constantinos J Stefanidis1, Günter Klaus

  • 1Department of Nephrology, P. & A. Kyriakou Children's Hospital of Athens, Goudi, 14562, Athens, Greece. stefanid@hol.gr

Pediatric Nephrology (Berlin, Germany)
|April 3, 2007
PubMed

Insights

Optimizing care for children on dialysis is crucial for preventing growth failure. Early intervention and comprehensive management of nutritional, metabolic, and hormonal issues are key to improving growth outcomes.

Area of Science:

  • Pediatric Nephrology
  • Pediatric Endocrinology
  • Pediatric Gastroenterology

Background:

  • Growth failure is a significant clinical issue for children undergoing dialysis, hindering their rehabilitation.
  • Growth impairment in these children is multifactorial, influenced by nutritional deficiencies, metabolic disturbances, and hormonal imbalances.

Purpose of the Study:

  • To highlight the importance of early intervention and comprehensive management strategies to prevent and treat growth failure in pediatric dialysis patients.
  • To outline key factors influencing growth in children on dialysis and provide recommendations for optimizing their care.

Main Methods:

  • Review of existing literature on growth in pediatric dialysis patients.
  • Analysis of factors affecting growth, including nutrition, bone metabolism, and hormonal status.
  • Discussion of management strategies, including nutritional support, dialysis adequacy, and pharmacotherapy.

Main Results:

  • Early referral and proactive management before dialysis initiation can prevent growth deterioration.
  • Aggressive management of malnutrition, metabolic acidosis, renal osteodystrophy, and anemia is essential.
  • Gastrostomy feeding and careful use of active vitamin D metabolites are important interventions.
  • Recombinant human growth hormone (rhGH) should be considered only after optimizing other aspects of care.

Conclusions:

  • Optimizing the comprehensive care of children on dialysis, addressing all contributing factors, is the primary strategy to reverse growth impairment.
  • Multidisciplinary management involving pediatric nephrologists, endocrinologists, and gastroenterologists is vital for successful growth outcomes.

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