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Dialysis strategies to improve growth in children with chronic kidney disease

Michel Fischbach1, Helen Fothergill, Laure Seuge

  • 1Pédiatrie 1, CHU de Hautepierre, Avenue Moliere, Strasbourg, France. Michel.Fischbach@chru-strasbourg.fr

Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation
|January 4, 2011
PubMed

Insights

Children with chronic kidney disease often experience uremic growth failure, resulting in short stature. Optimal clinical care, including nutritional support and treatments like recombinant human growth hormone (rhGH), can improve linear growth.

Area of Science:

  • Pediatrics
  • Nephrology
  • Endocrinology

Background:

  • Uremic growth failure affects 35-50% of children with chronic kidney disease (CKD), leading to short adult stature.
  • Growth retardation in pediatric CKD impacts psychosocial integration and increases mortality risk.
  • Growth failure is a common outcome in various conditions, including growth hormone resistance.

Purpose of the Study:

  • To review current understanding and management strategies for uremic growth failure in children.
  • To highlight the impact of growth retardation on pediatric CKD patients' quality of life and health outcomes.
  • To discuss interventions aimed at improving linear growth in children with CKD.

Main Methods:

  • Review of existing literature on pediatric chronic kidney disease and growth failure.
  • Analysis of factors influencing final adult height in children post-kidney transplantation.
  • Evaluation of management options including nutritional support, recombinant human growth hormone (rhGH), and dialysis intensification.

Main Results:

  • Limited catch-up growth occurs after kidney transplantation, with final height often correlated to pre-transplant deficit.
  • Optimal clinical care, including nutritional support, is crucial for improving linear growth in children on dialysis.
  • Recombinant human growth hormone (rhGH) and intensive dialysis (e.g., daily on-line hemodiafiltration) are potential therapeutic options.

Conclusions:

  • Despite advances, significant challenges remain in managing uremic growth failure in pediatric CKD.
  • Multifaceted management strategies are essential to optimize growth and improve outcomes for affected children.
  • Early and comprehensive intervention can mitigate the long-term consequences of growth retardation in pediatric CKD.

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