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[Height-weight development of uremic children undergoing dialysis and after kidney transplantation]
J L Andre1, J M de Bernardin, N Martinet
1Service de pédiatrie I, Hôpital d'Enfants, Vandoeuvre-lés-Nancy, France.
Insights
Children with end-stage renal disease experience significant growth delays. While renal transplantation can improve growth, especially in younger patients, metabolic disorders must be addressed early to optimize final height.
Area of Science:
- Pediatric Nephrology
- Growth and Development
Context:
- End-stage renal disease (ESRD) significantly impacts linear growth in children.
- Hemodialysis and renal transplantation are primary treatments for pediatric ESRD.
- Assessing growth patterns is crucial for managing long-term outcomes in these patients.
Purpose:
- To evaluate linear growth patterns in children with end-stage renal disease.
- To compare growth outcomes between hemodialysis and renal transplantation.
- To identify factors influencing final height in pediatric ESRD patients.
Summary:
- Children with ESRD showed a mean growth delay of 2 SD at the start of hemodialysis.
- Prepubertal children experienced an annual growth delay of 0.50 SD, while pubertal children had a slight catch-up of 0.10 SD.
- Renal transplantation stabilized growth curves, with some improvement seen in younger patients with functioning grafts.
- The pubertal growth spurt was delayed and less pronounced, but a prolonged spurt aided final height.
- Mean final stature was approximately 2 SD, with significant variability based on age of onset, transplant status, and renal function.
- Bone age prediction was effective for estimating adult height.
- Early management of metabolic disorders is vital to mitigate growth impairment.
Impact:
- Provides insights into growth trajectories for children with ESRD on different treatment modalities.
- Highlights the importance of timely intervention for metabolic disorders to improve growth outcomes.
- Informs clinical practice regarding growth monitoring and management strategies in pediatric nephrology.
Abstract:
Fifty-nine children with end stage renal disease treated by hemodialysis or renal transplantation have been assessed for linear growth. Mean follow-up duration of study was 6 years (0.25 to 15.5 yr). At the beginning of hemodialysis, the mean growth delay was 2 SD. Every year, prepubertal children were affected by a growth delay of 0.50 SD whereas pubertal children caught up by +0.10 SD. In patients with renal transplantation, the mean growth curve remained at the same standard deviation once the transplant had been performed. An increase in growth was exhibited in about one-third of this group provided the transplant functioned satisfactorily and the patient was under 11 years of age. The characteristic pubertal linear growth spurt was delayed and demonstrated a lower amplitude than in normal children; but if it took place over a prolonged period, a better final height was obtained. The mean final stature was about 2 SD. There was strong variability in the final height according to the age of renal failure onset, renal transplantation and the level of renal function. Bone age allowed adult height to be predicted. Metabolic disorders have to be dealth with as soon as possible in order to limit growth impairment.