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Growth in children with chronic kidney disease: 13 years follow up study
Petar Salević1, Pavle Radović, Nataša Milić
1Medical Faculty, University of Belgrade, Belgrade, Serbia, petar_salevic@yahoo.com.
Insights
Growth failure is common in children with chronic kidney disease (CKD). While dialysis doesn't improve growth, kidney transplantation significantly enhances stature in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Kidney Disease Management
Background:
- Growth retardation is a frequent comorbidity in pediatric chronic kidney disease (CKD).
- Longitudinal growth data for pediatric CKD patients in South-East Europe were previously unavailable.
- The Serbian Pediatric Registry of Chronic Kidney Disease provides crucial regional data.
Purpose of the Study:
- To analyze longitudinal growth patterns in children with CKD.
- To identify factors influencing growth failure and improvement in pediatric CKD.
- To report findings from the Serbian Pediatric Registry of CKD.
Main Methods:
- Prospective data collection from 2000 to 2012.
- Inclusion of 324 children diagnosed with CKD.
- Analysis of height standard deviation scores (HtSDS) and relevant clinical factors.
Main Results:
- Prevalence of growth failure was 29.3% at enrollment.
- Children with hereditary nephropathy exhibited poorer growth.
- Advanced CKD stages (4-5) correlated with short stature; dialysis was a negative predictor, while transplantation was a positive predictor for growth improvement.
Conclusions:
- Growth failure remains a significant challenge in pediatric CKD, particularly in hereditary forms.
- Standard dialysis does not improve growth outcomes.
- Kidney transplantation demonstrates a positive impact on improving stature in children with CKD.
Background:
Growth retardation is one of the most visible comorbid conditions of chronic kidney disease (CKD) in children. To our knowledge, published data on longitudinal follow-up of growth in pediatric patients with CKD is lacking from the region of South-East Europe. Herein we report the results from the Serbian Pediatric Registry of Chronic Kidney Disease.
Methods:
The data reported in the present prospective analysis were collected between 2000 and 2012. A total of 324 children with CKD were enrolled in the registry.
Results:
Prevalence of growth failure at registry entry was 29.3 %. Mean height standard deviation scores (HtSDS) in children with stunting and those with normal stature were -3.00 [95 % confidence interval (CI) -3.21 to -2.79] and -0.08 (95 % CI -0.22 to 0.05) (p < 0.001), respectively. Children with hereditary nephropathy had worse growth at registration (-1.51; 95 % CI -1.97 to -1.04, p = 0.008). Those with CKD stages 4 and 5 before registration had more chance to have short stature at registration than those with CKD stages 2 and 3 [odds ratio (OR) = 0.458, CI 0.268-0.782, p = 0.004]. Dialysis was an independent negative predictor for maintaining optimal stature during the follow-up period (OR = 0.324, CI = 0.199-0.529, p < 0.001), while transplantation was an independent positive predictor for improvement of small stature during follow-up (OR = 3.706, CI = 1.785-7.696, p < 0.001).
Conclusion:
Growth failure remains a significant problem in children with CKD, being worst in patients with hereditary renal disease. Growth is not improved by standard dialysis, but transplantation has a positive impact on growth in children.
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