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Nutrition and growth in pediatric renal transplant recipients
Insights
Pediatric patients with renal failure experience growth retardation on dialysis, with the worst outcomes observed in those not dialyzed before transplantation. Renal transplantation consistently improves growth in these young patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Renal Replacement Therapy
Background:
- Children with end-stage renal disease (ESRD) often suffer from growth retardation.
- Dialysis modalities may differentially impact growth in pediatric ESRD patients.
- Nutritional support and timing of renal replacement therapy are critical factors in pediatric growth.
Purpose of the Study:
- To evaluate the impact of different dialysis strategies and pre-transplant interventions on growth in pediatric renal failure patients.
- To assess the effect of renal transplantation on growth in children with ESRD.
- To determine if nutritional intake influences growth outcomes in this population.
Main Methods:
- Retrospective analysis of growth parameters in pediatric patients with renal failure undergoing various dialysis treatments and renal transplantation.
- Comparison of growth rates across different pre-transplant management groups, including those on tube feeding (TF).
- Assessment of growth velocity before and after renal transplantation.
Main Results:
- All dialysis modalities were associated with similar rates of growth retardation.
- Patients not dialyzed before transplantation and those on tube feeding (TF) exhibited the most severe growth retardation, with an average transplant age of 27 months.
- Growth declined progressively with longer intervals between diagnosis and transplantation, irrespective of caloric intake.
- Pre-transplant TF showed a trend toward improved post-transplant catch-up growth but no significant pre-transplant effect.
- Renal transplantation uniformly led to improved growth in the studied pediatric population.
Conclusions:
- Growth retardation is a significant concern in pediatric patients with renal failure, regardless of dialysis type.
- Optimal timing of renal transplantation is crucial for improving growth outcomes.
- While pre-transplant nutritional support like TF may aid post-transplant recovery, renal transplantation remains the most effective intervention for normalizing growth in children with ESRD.
Abstract:
Pediatric renal failure patients undergo similar rates of growth retardation on all forms of dialysis, but appears to be worst in the patients not dialyzed before transplant and on TF. These patients had an average age of 27 months before transplant. Table 1 shows that all groups undergo progressive decline in growth as the interval from diagnosis to transplant increases. This is not affected by the number of calories supplied. Pretransplant TF seems to improve catch up growth after transplant, but we saw no definite effect on growth in the pretransplant period. Renal transplantation uniformly improves growth in this population.