Advertisement

Pediatric Nephrology

, Volume 21, Issue 6, pp 793–799 | Cite as

Stature in children with chronic kidney disease: analysis of NAPRTCS database

  • Mouin G. SeikalyEmail author
  • Nina Salhab
  • Debbie Gipson
  • Verna Yiu
  • Donald Stablein
Original Article

Abstract

Despite recent advances in the management of children with chronic kidney disease (CKD), growth remains suboptimal. The purpose of this study was to evaluate factors associated with short stature in children with CKD. We evaluated the chronic renal failure registry of the North American Pediatric Renal Transplant Cooperative Studies (NAPRTCS) to determine the relations among primary diagnosis, age, race, residual renal function, acidosis, anemia, serum phosphorous, calcium, parathyroid hormone (PTH), albumin, and height at entry into the registry in children with CKD. A total of 5,615 patients were entered into the registry between January 1994 and January 2004. We found that older patients, those with glomerular filtration rate (GFR) >50 ml min−1 1.73 m−2, black patients and patients with focal segmental glomerulosclerosis (FSGS) were at lower risk of being short at entry. Anemia (hematocrit below 33%) was an independent risk factor for short stature. Acidosis, serum phosphorous, calcium, albumin and PTH at registration were poor predictors of short stature. Age, race, primary diagnosis, and residual renal function were associated with short stature in children with CKD.

Keywords

Chronic Kidney Disease Glomerular Filtration Rate Short Stature Standard Deviation Score Serum Phosphorous 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

GFR

Glomerular filtration rate

CKD

Chronic kidney disease stage 2–4 as defined in [1]

NAPRTCS

North American Pediatric Renal Transplant Cooperative Studies

SDS

Standard deviation score

rhGH

Recombinant human growth hormone

ClCr

Estimated creatinine clearance as described in [14] and [15]

PTH

Parathyroid hormone

FSGS

Focal segmental glomerulosclerosis

Notes

Acknowledgement

We are indebted to the secretarial support of Ms. Sharon Blend.

References

  1. 1.
    Eknoyan G, Levin NW (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 39:S14–S214CrossRefGoogle Scholar
  2. 2.
    Seikaly MG, Ho PI, Emmett L, Fine RN, Tejani A (2003) Chronic Renal insufficiency in children: annual report of NAPRTCS. Pediatr Nephrol 18:796–804CrossRefGoogle Scholar
  3. 3.
    Hokken-Koelega A, Mulder P, De Jong R, Lilien M, Donckerwolcke R, Groothof J (2000) Long-term effects of growth hormone treatment on growth and puberty in patients with chronic renal insufficiency. Pediatr Nephrol 14:701–706CrossRefGoogle Scholar
  4. 4.
    Foreman J, Abitbol CL, Trachtman H, Garin EH, Feld LG, Strife CF, Massie MD, Boyle RM, Chan JC (1996) Nutritional intake in children with renal insufficiency: a report of the growth failure in children with renal diseases study. J Am Coll Nutr 15:579–585CrossRefGoogle Scholar
  5. 5.
    Tonshoff B, Kiepe D, Ciarmatori S (2005) Growth hormone/insulin like growth factor system in children with chronic renal failure. Pediatr Nephrol 20:279–289CrossRefGoogle Scholar
  6. 6.
    Tonshoff B, Mehls O (1995) Growth retardation in children with chronic renal insufficiency: current aspects of pathophysiology and treatment. J Nephrol 8:133–142Google Scholar
  7. 7.
    Hokken-Koelega AC, Saenger P, Cappa M, Greggio N (2001) Unresolved problems concerning optimal therapy of puberty in children with chronic renal diseases. J Pediatr Endocrinol Metab 14 (Suppl 2):945–952PubMedGoogle Scholar
  8. 8.
    Tonshoff B, Blurn WF, Mehls O (1997) Derangements of somatropic hormone axis in chronic renal failure. Kidney Int 58(Suppl):S106–S113Google Scholar
  9. 9.
    Roelfsema V, Clark RG (2001) The growth hormone and insulin-like growth factor axis: its manipulation for the benefit of growth disorders in renal failure. J Am Soc Nephrol 12:1297–1306PubMedGoogle Scholar
  10. 10.
    Fine RN, Khaut EC, Brown D, Perlman AJ (1994) Growth after recombinant human growth hormone therapy in children with chronic renal failure: report of a multicenter and double-blind placebo-control study. J Pediatr 124:374–382CrossRefGoogle Scholar
  11. 11.
    Haffner D, Schaefer F, Nissel R, Wuhl E, Tonshoff B,Mehls O (2000) Effect of growth hormone treatment on adult height of children with chronic renal failure. N Eng J Med 343:923–930CrossRefGoogle Scholar
  12. 12.
    McSherry E, Morris Jr RC (1978) Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. J Clin Invest 61:509–527CrossRefGoogle Scholar
  13. 13.
    Abitbol CL, Zilleruelo G, Montane B, Strauss J (1993) Growth of uremic infants on forced feeding regimens. Pediatr Nephrol 7:173–177CrossRefGoogle Scholar
  14. 14.
    Stickler GB, Bergen BJ (1973) A review: short stature in renal disease. Pediatr Res 7:978–982CrossRefGoogle Scholar
  15. 15.
    Chesney RW, Moorthy AV, Eisman JA, Jax DK, Mazess RB, DeLuca HF (1978) Increased growth after long-term oral 1 alpha, 25-vitamin D3 in childhood renal osteodystrophy. N Engl J Med 298:238–242CrossRefGoogle Scholar
  16. 16.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41CrossRefGoogle Scholar
  17. 17.
    Schwartz GJ, Haycock GB, Edelmann Jr CM, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMedPubMedCentralGoogle Scholar
  18. 18.
    National Center for Health Statistics, Center for Disease Control (2005) United States growth charts. https://doi.org/www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm
  19. 19.
    Parekh RS, Flynn JT, Smoyer WE, Milne JL, Kershaw DB, Bunchman TE, Sedman AB (2001) Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol 12:2418–2426PubMedGoogle Scholar
  20. 20.
    Maniar S, Kleinknecht C, Zhou X, Motel V, Yvert JP, Dechaux M (1996) Growth hormone action is blunted by acidosis in experimental uremia or acid load. Clin Nephrol 46:72–76PubMedGoogle Scholar
  21. 21.
    Bushinsky DA, Frick KK (2000) The effect of acid on bone. Curr Opin Nephrol Hyperten 9:369–379CrossRefGoogle Scholar
  22. 22.
    Nash MA, Torrado AD, Greifer I, Spitzer A, Edelmann CM Jr (1972) Renal tubular acidosis in infants and children. Clinical course, response to treatment, and prognosis. J Pediatr 80:738–748CrossRefGoogle Scholar
  23. 23.
    Betts PR, Magrath G (1974) Growth pattern and dietary intake of children with chronic renal insufficiency. Br Med J 2:189–193CrossRefGoogle Scholar
  24. 24.
    Potter DE, Greifer I (1978) Statural growth of children with renal disease. Kidney Int 14:334–339CrossRefGoogle Scholar
  25. 25.
    Tarng DC, Huang TP, Doong TI (1998) Improvement of nutritional status in patients receiving maintenance hemodialysis after correction of renal anemia with recombinant human erythropoietin. Nephron 78:253–259CrossRefGoogle Scholar
  26. 26.
    Obrador GT, Ruthazer R, Arora P, Kausz AT, Pereira BJ (1999) Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol 10:1793–1800PubMedGoogle Scholar
  27. 27.
    Rees L, Rigden SPA, Chantler C (1991) The influence of steroid therapy and recombinant human erythropoietin on the growth of children with renal disease. Pediatr Nephrol 5:556–558CrossRefGoogle Scholar
  28. 28.
    Gagnadoux MF, Loirat C, Bertheleme JP, Maisin A, Kamoun A, Dabout D, Poisson D, Broyer M (1994) Treatment of anemia in hemodialyzed children using recombinant human erythropoietin (Eprex). Results of a French multicenter clinical trial. Nephrologie 15:207–211PubMedGoogle Scholar
  29. 29.
    Hodson EM, Shaw PF, Evans RA, Dunstan CR, Hills EE, Wong SY, Rosenberg AR, Roy LP (1983) Growth retardation and renal osteodystrophy in children with chronic renal failure. J Pediatr 103:735–740CrossRefGoogle Scholar
  30. 30.
    Coppo KR, Porcellini MG, Bonaudo R, Peruzzi L, Amore A, Conti G (1998) Providing the right stuff: feeding children with chronic renal failure. J Nephrol 11:171–176PubMedGoogle Scholar
  31. 31.
    Klaus G, Meinhold-Heerlein R, Milde P, Ritz E, Mehls O (1991) Effect of vitamin D on growth cartilage cell proliferation in vitro. Pediatr Nephrol 5:461–466CrossRefGoogle Scholar
  32. 32.
    Seikaly MG, Browne R, Baum M (1994) The effect of phosphate supplementation on linear growth in children with X-linked hypophosphatemia. Pediatrics 94:478–481PubMedGoogle Scholar
  33. 33.
    Shah M, Salhab N, Patterson D, Seikaly MG (2000) Nutritional rickets still afflicts children in the southwestern United States. Tex Med 96:64–68PubMedGoogle Scholar
  34. 34.
    Goodman WG, Ramirex JA, BelinTR, Chon Y, Gales B, Serge GV, Salusky IB (1994) Development of adynamic bone disease in patients with secondary hyperthyroidism after intermittent calcitriol. Kidney Int 46:1160–1166CrossRefGoogle Scholar
  35. 35.
    Goodman WG, Veldhuis JD, Behlin TR, Juppner H, Salusky IB (1997) Suppressive effect of calcium on parathyroid hormone release in adynamic renal osteodystrophy and secondary hyperparathyroidism. Kidney Int 51:1590–1595CrossRefGoogle Scholar
  36. 36.
    Norman LJ, Coleman JE, Macdonald IA (2000) Nutrition and growth in relation to severity of renal disease in children. Pediatr Nephrol 15:259–265CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  • Mouin G. Seikaly
    • 1
    • 2
    Email author
  • Nina Salhab
    • 2
  • Debbie Gipson
    • 3
  • Verna Yiu
    • 4
  • Donald Stablein
    • 5
  1. 1.Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Children’s Medical Center of DallasDallasUSA
  3. 3.Department of PediatricsUniversity of North CarolinaChapel HillUSA
  4. 4.Department of PediatricsUniversity of AlbertaEdmontonCanada
  5. 5.Department of PediatricsThe EMMES CorporationRockvilleUSA

Personalised recommendations