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Long-term outcome of infants with severe chronic kidney disease

Djalila Mekahli1, Vanessa Shaw, Sarah E Ledermann

  • 1Renal Office, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.

Clinical Journal of the American Society of Nephrology : CJASN
|December 8, 2009
PubMed

Insights

Children with severe chronic kidney disease (CKD) experienced impaired growth, but intensive feeding and early kidney transplant improved outcomes. Comorbidities significantly impacted final height in these young CKD patients.

Area of Science:

  • Pediatric Nephrology
  • Chronic Kidney Disease Research
  • Growth and Development Studies

Background:

  • Long-term outcomes for infants with severe chronic kidney disease (CKD) are not well-documented.
  • Previous reports detailed 101 children with a glomerular filtration rate (GFR) <20 ml/min/1.73 m2 at a median age of 0.3 years.

Purpose of the Study:

  • To reanalyze long-term data on mortality, treatment, and growth in children with severe CKD.
  • To investigate the impact of comorbidities on growth and final height in this cohort.

Main Methods:

  • Retrospective analysis of 101 children with severe CKD (GFR <20 ml/min/1.73 m2).
  • Data reanalyzed approximately 9.9 years after initial reporting, covering a total follow-up of up to 22.9 years.
  • Evaluation of mortality, treatment modalities (tube feeding, gastrostomy, Nissen fundoplication), and growth parameters (height SD score).

Main Results:

  • Overall survival at 22 years was 64%.
  • Comorbidities were present in 51% of patients and adversely affected growth (P < 0.01) and final height (P = 0.02).
  • Mean height SD score at birth was -0.42, declining to -2.07 at 0.5 years, and improving to -1.68 in adulthood for those without comorbidities.

Conclusions:

  • Comorbidity significantly influences growth and final height in infants with severe CKD.
  • Intensive nutritional support and early kidney transplantation can lead to normal adult height in patients without comorbidities.
  • Overall mortality in this cohort is comparable to that of older children with CKD.
Abstract

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