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Height at First RRT and Mortality in Children
Elaine Ku1,2, Richard N Fine3, Chi-Yuan Hsu1
1Division of Nephrology, Department of Medicine.
Insights
Children with short or tall stature face increased mortality risk after starting renal replacement therapy (RRT). This risk is influenced by body mass index, with tall stature posing a higher risk in obese children.
Area of Science:
- Pediatric Nephrology
- Clinical Epidemiology
- Biostatistics
Background:
- Poor linear growth is common in pediatric chronic kidney disease (CKD) and linked to higher mortality.
- Adult dialysis patients with tall stature show increased mortality risk.
- The impact of extreme height on mortality in children starting renal replacement therapy (RRT) requires investigation.
Purpose of the Study:
- To investigate the association between short or tall stature and all-cause mortality in children initiating RRT.
- To examine cause-specific mortality risks in children with extreme heights.
- To explore potential modifying effects of body mass index (BMI) on height-related mortality risk.
Main Methods:
- Retrospective analysis of 13,218 children (aged 2-19 years) from the US Renal Data System (1995-2011).
- Children received their first RRT (dialysis or transplant).
- Adjusted Cox models assessed the association between height percentiles (<3rd and >3rd) and mortality risk.
Main Results:
- Increased mortality risk observed in both short stature (HR, 1.49) and tall stature (HR, 1.32) children.
- A significant interaction between height and BMI (P=0.04) indicated that tall stature's mortality risk was primarily in children with elevated BMI (≥95th percentile).
- Short stature linked to higher cardiac and infection-related deaths; tall stature linked to higher cancer-related deaths.
Conclusions:
- Both short and tall stature are associated with increased mortality risk in children initiating RRT.
- Body mass index modifies the association between tall stature and mortality.
- Further research is needed to elucidate the mechanisms underlying heightened mortality risk in children with extreme heights.
Background And Objectives:
Poor linear growth is common in children with CKD and has been associated with higher mortality. However, recent data in adult dialysis patients have suggested a higher risk of death in persons of tall stature. In this study, we aimed to examine the risk of all-cause and cause-specific mortality in children at both extremes of height at the time of first RRT.
Design, Setting, Participants, & Measurements:
Using the US Renal Data System, we performed a retrospective analysis of 13,218 children aged 2-19 years, who received their first RRT (dialysis or transplant) during 1995-2011. We used adjusted Cox models to examine the association between short (<3rd percentile) and tall (>3rd percentile) stature and risk of death, compared with less extreme heights.
Results:
Over a median follow-up of 7.1 years, there were 1721 deaths. Risk of death was higher in children with short (hazard ratio, 1.49; 95% confidence interval, 1.33 to 1.66) and tall stature (hazard ratio, 1.32; 95% confidence interval, 1.03 to 1.69) in adjusted analysis. In secondary analyses, there was a statistically significant interaction between height and body mass index categories (P=0.04), such that the association of tall stature with higher mortality was limited to children with elevated body mass index (defined as ≥95th percentile for age and sex). Children with short stature had a higher risk of cardiac- and infection-related death, whereas children with tall stature had a higher risk of cancer-related death.
Conclusions:
Children with short and tall stature are at higher mortality risk, although this association was modified by body mass index at time of first RRT. Studies to further explore the reasons behind the higher risk of mortality in children with extremes of height at the time of first RRT are warranted.
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