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Linear growth in pediatric hemodialysis patients

Gregory Gorman1, Diane Frankenfield, Barbara Fivush

  • 1Department of Pediatrics, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. ggorman@usuhs.mil

Pediatric Nephrology (Berlin, Germany)
|October 16, 2007
PubMed

Insights

Pediatric hemodialysis patients experience growth issues. Younger age, longer dialysis duration, and higher protein intake negatively impact growth, while girls show improved growth. Growth hormone did not significantly affect height changes.

Area of Science:

  • Pediatric Nephrology
  • Growth and Development
  • Renal Replacement Therapy

Background:

  • Growth is a critical indicator of health in children with chronic kidney disease.
  • Pediatric patients undergoing hemodialysis (HD) often face challenges in achieving adequate growth.
  • Understanding factors influencing growth in this population is essential for improving outcomes.

Purpose of the Study:

  • To identify key factors associated with growth velocity in pediatric patients on maintenance hemodialysis.
  • To analyze the impact of demographic, clinical, and treatment-related variables on height standard deviation scores (Ht SDS) over time.

Main Methods:

  • Retrospective analysis of height data from 407 pediatric hemodialysis patients.
  • Calculation of height standard deviation scores (Ht SDS) change per year.
  • Multiple linear regression models were used to assess the influence of various factors on growth.

Main Results:

  • The mean change in Ht SDS per year was -0.10.
  • Decreased Ht SDS was significantly associated with younger age, longer duration on dialysis, and higher normalized protein catabolic rate (nPCR).
  • Improved growth was observed in girls and in patients with lower baseline Ht SDS. Hemoglobin, growth hormone (GH) use, and dialysis adequacy showed no significant association with growth changes.

Conclusions:

  • Growth retardation in pediatric hemodialysis patients is multifactorial, with younger age, male sex, longer dialysis duration, and higher nPCR being significant contributors.
  • Current growth hormone therapies and dialysis adequacy metrics may not be sufficient to overcome these growth challenges.
  • Further research into optimizing nutritional and hormonal interventions is warranted to improve growth outcomes.

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