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Growth of children with end-stage renal disease undergoing daily hemodialysis
Maria Fernanda Carvalho de Camargo1, Cristina Lucia Henriques, Simone Vieira
1Dialysis and Pediatric Kidney Transplants, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil.
Insights
Daily hemodialysis (DHD) improved growth in children with end-stage renal disease (ESRD), with 33% achieving significant height gain without growth hormone therapy. DHD is a viable option for selected pediatric ESRD patients.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- End-stage renal disease (ESRD) significantly impacts pediatric growth.
- Conventional hemodialysis (CHD) often fails to adequately support growth in children with ESRD.
Purpose of the Study:
- To evaluate the effect of daily hemodialysis (DHD) on the growth of children with ESRD.
- To compare growth outcomes between DHD and CHD in pediatric ESRD patients not receiving growth hormone therapy.
Main Methods:
- Prospective observational study involving 24 children on DHD and 26 on CHD.
- Follow-up duration of 9.3 ± 3.0 months.
- Growth assessed by height-for-age Z-score; no growth hormone therapy administered.
Main Results:
- Daily hemodialysis (DHD) favored a 0.5 SDS height gain in 33% of patients, compared to 8% on conventional hemodialysis (CHD) (p=0.035).
- Cumulative height gain probability at 12 months was 40% for DHD versus 15% for CHD (p=0.047).
- Adequate caloric intake was achieved by 98% of DHD patients vs. 38% of CHD patients (p<0.001).
Conclusions:
- Daily hemodialysis (DHD) promotes significant height gain in a substantial proportion of pediatric ESRD patients without growth hormone treatment.
- DHD is a safe and effective dialysis modality, with no dropouts due to treatment intensification.
- DHD should be considered for selected pediatric ESRD cases, particularly in younger children, to improve growth outcomes.
Background:
The aim of this report is to describe the effect of daily hemodialysis on the growth of children with end-stage renal disease (ESRD).
Methods:
We performed a prospective, observational study on 24 children with ESRD undergoing daily hemodialysis (DHD). The control group comprised 26 children on concurrent conventional hemodialysis (CHD), and the follow-up for both groups was 9.3 ± 3.0 months. No patient received growth hormone (GH) therapy.
Results:
At the onset of the study, the height-for-age Z-score was -2.12 ± 1.54 in the CHD group and -2.84 ± 2.27 in the DHD group (p = 0.313). Assuming an increase of 0.5 standard deviation scores (SDS) of the height-for-age parameter as an improvement of growth, there were 33 % of patients in the DHD group and 8 % in the CHD group (p = 0.035). The cumulative probability of gain in height for age at 12 months was 40 % in the DHD group versus 15 % in the CHD group (p = 0.047). Also, 98 % of patients in the DHD group had an adequate total caloric intake, whereas 38 % in the CHD group reached this goal (p < 0.001). No patient left the study due to intensification of the dialysis modality.
Conclusions:
Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.
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