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Association between BMI changes and mortality risk in children with end-stage renal disease

Matthew J Roberts1, Mark M Mitsnefes2, Charles E McCulloch3

  • 1School of Medicine, University of California San Francisco, 533 Parnassus Avenue, U404, Box 0532, San Francisco, CA, 94143-0532, USA. matthew.roberts@ucsf.edu.

Pediatric Nephrology (Berlin, Germany)
|April 10, 2019
PubMed

Insights

Maintaining a stable body mass index (BMI) in children undergoing renal replacement therapy (RRT) is linked to better survival rates. Significant BMI changes, both increases and decreases, are associated with higher mortality risk in this vulnerable pediatric population.

Area of Science:

  • Pediatric Nephrology
  • Clinical Epidemiology
  • Growth and Development

Background:

  • Limited research exists on the impact of Body Mass Index (BMI) changes over time on adverse outcomes in pediatric patients undergoing Renal Replacement Therapy (RRT).
  • Understanding these associations is crucial for improving patient management and long-term prognosis.

Purpose of the Study:

  • To investigate the relationship between annualized changes in BMI z-score and the risk of mortality in children receiving RRT.
  • To identify optimal BMI trajectories for survival in pediatric RRT patients.

Main Methods:

  • A retrospective cohort study was conducted using data from 1182 pediatric patients in the US Renal Data System.
  • Annualized BMI z-score changes were categorized into quintiles, with Cox models used to assess associations with mortality.
  • Analysis began from the second BMI measurement, with a median follow-up of 6 years.

Main Results:

  • A U-shaped association was observed between BMI change and mortality risk.
  • Significant declines (>-0.50) and increases (>0.57) in BMI z-score were associated with a higher risk of death (aHR 1.54 and 1.44, respectively).
  • No significant interaction was found between BMI change and the type of RRT (dialysis or transplant).

Conclusions:

  • Maintaining a stable BMI in pediatric patients undergoing RRT may be associated with improved survival outcomes.
  • Monitoring and managing BMI fluctuations are important considerations in the care of children with kidney disease requiring RRT.
Abstract

Keywords:
Body mass indexESRDMalnutritionObesityPediatrics

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