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Time from kidney failure onset to transplantation and its impact on growth in pediatric patients
Regina Gabriela Garcia Rheda1, Aline Maria Luiz Pereira1, José Medina Pestana2
1Pediatrics Department, UNIFESP, São Paulo, Brasil.
Insights
Children with recent kidney failure onset experienced shorter wait times for kidney transplants. This reduced treatment duration was linked to improved height outcomes in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Growth and Development
Background:
- Prolonged dialysis in pediatric kidney failure negatively impacts growth, quality of life, and life expectancy.
- Understanding the relationship between treatment timelines and patient outcomes is crucial for improving care.
Purpose of the Study:
- To investigate if treatment time from kidney failure diagnosis to transplantation has shortened in pediatric patients.
- To determine if this time interval influences final height in children undergoing kidney transplantation.
Main Methods:
- Retrospective cohort study analyzing data from 2005 to 2018.
- Utilized Cox regression to assess factors influencing time to transplantation and linear regression for height-associated variables.
- Evaluated 780 children, with 517 undergoing kidney transplantation.
Main Results:
- The median time to kidney transplantation was 1.9 years.
- Factors influencing transplant time included year of kidney failure onset, age at onset, geographic location, and pre-transplant blood transfusions.
- Each 1-year increase in the year of kidney failure onset correlated with a 0.05 SDS increase in height-for-age.
Conclusions:
- Earlier onset of kidney failure in children is associated with shorter time to transplantation.
- Reduced time to kidney transplantation is linked to less severe growth deficits in pediatric patients.
Background:
In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height.
Methods:
Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height.
Results:
A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05-1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49-0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53-0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53-0.75; p < .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001).
Conclusion:
Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.
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