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Sullivan KM, Kriegel AJ. Growth hormone in pediatric chronic kidney disease: more than just height. Pediatr Nephrol 2024:10.1007/s00467-024-06330-8. [PMID: 38607423 DOI: 10.1007/s00467-024-06330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
Recombinant human growth hormone therapy, which was introduced in the 1980s, is now routine for children with advanced chronic kidney disease (CKD) who are exhibiting growth impairment. Growth hormone usage remains variable across different centers, with some showing low uptake. Much of the focus on growth hormone supplementation has been on increasing height because of social and psychological effects of short stature. There are, however, numerous other changes that occur in CKD that have not received as much attention but are biologically important for pediatric growth and development. This article reviews the current knowledge about the multisystem effects of growth hormone therapy in pediatric patients with CKD and highlights areas where additional clinical research is needed. We also included clinical data on children and adults who had received growth hormone for other indications apart from CKD. Ultimately, having robust clinical studies which examine these effects will allow children and their families to make more informed decisions about this therapy.
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Affiliation(s)
- Katie Marie Sullivan
- Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alison J Kriegel
- Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
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Ng NSL, Gajendran S, Plant N, Shenoy M. Evaluation of height centile growth patterns compared with parental-adjusted target height following kidney transplantation. Pediatr Transplant 2023; 27:e14508. [PMID: 36919675 DOI: 10.1111/petr.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Early steroid withdrawal (ESW) improves growth following kidney transplant (KT). It is not known whether these children achieve target height within mid-parental height range post-KT. METHODS Retrospective analysis of growth patterns of KT recipients following ESW in our center between 2009 and 2020 had minimum follow-up period of 12 months. RESULTS Forty-eight (female 29.2%) KT recipients, median age 5.3 years at first KT, were included. At KT, 29 (60.4%) recipients had normal height (SDS≥-1.88) and in 23 (47.9%), the height was within their target height (parental-adjusted height SDS within ±1.55). The proportion of children achieving normal height at 1-, 2-, 3-, and 5-years post-KT (median 5.5 years) were 75%, 83.3%, 86.5%, and 88% respectively. The proportion of children achieving target height measured at the same intervals was 68.8%, 73.8%, 73%, and 80%, respectively. Children <6 years were most growth impaired at KT but were most likely to achieve target height within first-year post-KT (72%; p = .023). All 19 children with short stature at KT received dialysis. Three children received growth hormone post-KT. Children who did not achieve target height post-KT (n = 14), five had eGFR <60 mL/min/1.73 m2 , and eight were on corticosteroid therapy at latest follow-up. CONCLUSIONS Although vast majority of children achieved normal height post-KT following ESW during the first 5 years post-KT, 20% of these children had not achieved their target height post-KT.
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Affiliation(s)
- Natasha Su Lynn Ng
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sellathurai Gajendran
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicholas Plant
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
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Bechara R, Rossignol S, Zaloszyc A. [Chronic kidney disease and growth failure: Efficacy of growth hormone treatment]. Med Sci (Paris) 2023; 39:271-280. [PMID: 36943125 DOI: 10.1051/medsci/2023034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Growth failure is a frequent complication observed in children with chronic kidney disease (CKD) and correlated to increased morbidity and mortality. To achieve a normal growth in children with CKD remains challenging for pediatric nephrologists. Growth failure in the setting of pediatric CKD is multifactorial and related to an impaired sensitivity to growth hormone and to a deficiency of IGF1 (insulin-like growth factor 1). Growth failure management has improved during the last two decades and consists of correcting any nutritional and metabolic abnormalities, of an improvement of dialysis for children on end-stage renal disease, and of an administration of a supraphysiologic dose of recombinant growth hormone to overcome GH insensitivity. This article summarizes the causes, outcomes and assessment tools of growth in children with CKD as well as the management of recombinant growth hormone.
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Affiliation(s)
- Rouba Bechara
- Pédiatrie 1, CHU de Hautepierre, Hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Sylvie Rossignol
- Pédiatrie 1, CHU de Hautepierre, Hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Ariane Zaloszyc
- Pédiatrie 1, CHU de Hautepierre, Hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
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Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation. Pediatr Nephrol 2022; 37:859-869. [PMID: 34542703 PMCID: PMC8960657 DOI: 10.1007/s00467-021-05222-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) is frequently used for treatment of short stature in children with chronic kidney disease (CKD) prior to kidney transplantation (KT). To what extent this influences growth and transplant function after KT is yet unknown. METHODS Post-transplant growth (height, sitting height, leg length) and clinical parameters of 146 CKD patients undergoing KT before the age of 8 years, from two German pediatric nephrology centers, were prospectively investigated with a mean follow-up of 5.56 years. Outcome in patients with (rhGH group) and without (non-prior rhGH group) prior rhGH treatment was assessed by the use of linear mixed-effects models. RESULTS Patients in the rhGH group spent longer time on dialysis and less frequently underwent living related KT compared to the non-prior rhGH group but showed similar height z-scores at the time of KT. After KT, steroid exposure was lower and increments in anthropometric z-scores were significantly higher in the rhGH group compared to those in the non-prior rhGH group, although 18% of patients in the latter group were started on rhGH after KT. Non-prior rhGH treatment was associated with a faster decline in transplant function, lower hemoglobin, and higher C-reactive protein levels (CRP). After adjustment for these confounders, growth outcome did statistically differ for sitting height z-scores only. CONCLUSIONS Treatment with rhGH prior to KT was associated with superior growth outcome in prepubertal kidney transplant recipients, which was related to better transplant function, lower CRP, less anemia, lower steroid exposure, and earlier maturation after KT. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Bonthuis M, Harambat J, Jager KJ, Vidal E. Growth in children on kidney replacement therapy: a review of data from patient registries. Pediatr Nephrol 2021; 36:2563-2574. [PMID: 34143298 PMCID: PMC8260545 DOI: 10.1007/s00467-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
Growth retardation is a major complication in children with chronic kidney disease (CKD) and on kidney replacement therapy (KRT). Conversely, better growth in childhood CKD is associated with an improvement in several hard morbidity-mortality endpoints. Data from pediatric international registries has demonstrated that improvements in the overall conservative management of CKD, the search for optimal dialysis, and advances in immunosuppression and kidney transplant techniques have led to a significant improvement of final height over time. Infancy still remains a critical period for adequate linear growth, and the loss of stature during the first years of life influences final height. Preliminary new original data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry confirm an association between the final height and the height attained at 2 years in children on KRT.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, J1B-108.1, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux, Bordeaux, France
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, J1B-108.1, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
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Borzych-Dużałka D, Schaefer F, Warady BA. Targeting optimal PD management in children: what have we learned from the IPPN registry? Pediatr Nephrol 2021; 36:1053-1063. [PMID: 32458134 PMCID: PMC8009785 DOI: 10.1007/s00467-020-04598-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022]
Abstract
National and international registries have great potential for providing data that describe disease burden, treatments, and outcomes especially in rare diseases. In the setting of pediatric end-stage renal disease (ESRD), the available data are limited to highly developed countries, whereas the lack of data from emerging economies blurs the global perspective. In order to improve the pediatric dialysis care worldwide, provide global benchmarking of pediatric dialysis outcome, and assign useful tools and management algorithms based on evidence-based medicine, the International Pediatric Peritoneal Dialysis Network (IPPN) was established in 2007. In recent years, the Registry has provided comprehensive data on relevant clinical issues in pediatric peritoneal dialysis patients including nutritional status, growth, cardiovascular disease, anemia management, mineral and bone disorders, preservation of residual kidney function, access-related complications, and impact of associated comorbidities. A unique feature of the registry is the ability to compare practices and outcomes between countries and world regions. In the current review, we describe study design and collection methods, summarize the core IPPN findings based on its 12-year experience and 13 publications, and discuss the future perspective.
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Affiliation(s)
- Dagmara Borzych-Dużałka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland.
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania. ACTA ACUST UNITED AC 2021; 57:medicina57020112. [PMID: 33530599 PMCID: PMC7912265 DOI: 10.3390/medicina57020112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: The data on the prevalence of chronic kidney disease (CKD) in the pediatric population are limited. The prevalence of CKD ranges from 56 to 74.7 cases per million of the age-related population (pmarp). The most common cause of CKD among children is congenital anomalies of the kidney and urinary tract (CAKUT). With progressing CKD, various complications occur, and end-stage renal disease (ESRD) can develop. The aim of the study was to determine the causes, stage, prevalence, and clinical signs of CKD and demand for RRT (renal replacement therapy) among Lithuanian children in 2017 and to compare the epidemiological data of CKD with the data of 1997 and 2006. Materials and Methods: The data of 172 Lithuanian children who had a diagnosis of CKD (stage 2–5) in 1997 (n = 41), in 2006 (n = 65), and in 2017 (n = 66) were retrospectively analyzed. Physical development and clinical signs of children who had CKD (stage 2–5) in 2017 were assessed. Results: The prevalence of CKD stages 2–5 was 48.0 pmarp in 1997; 88.7 in 2006; and 132.1 in 2017 (p < 0.01). Congenital and hereditary diseases of the kidney in 1997 accounted for 66% of all CKD causes; in 2006, for 70%; and in 2017, for 79%. In 2017, children with CKD stages 4 or 5 (except transplanted children) had hypertension (87.5%) and anemia (50%) (p < 0.01). Children under ≤2 years with CKD were at a 3-fold greater risk of having elevated blood pressure (OR = 3.375, 95% CI: 1.186–9.904). Conclusions: There was no change in the number of children with CKD in Lithuania; however, the prevalence of CKD increased due to reduced pediatric population. CAKUT remains the main cause of CKD at all time periods. Among children with CKD stages 4 or 5, there were more children with hypertension and anemia. In children who were diagnosed with CKD at an early age hypertension developed at a younger age.
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Growth Patterns After Kidney Transplantation in European Children Over the Past 25 Years: An ESPN/ERA-EDTA Registry Study. Transplantation 2020; 104:137-144. [PMID: 30946218 DOI: 10.1097/tp.0000000000002726] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improved management of growth impairment might have resulted in less growth retardation after pediatric kidney transplantation (KT) over time. We aimed to analyze recent longitudinal growth data after KT in comparison to previous eras, its determinants, and the association with transplant outcome in a large cohort of transplanted children using data from the European Society for Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry. METHODS A total of 3492 patients transplanted before 18 years from 1990 to 2012 were included. Height SD scores (SDS) were calculated using recent national or European growth charts. We used generalized equation models to estimate the prevalence of growth deficit and linear mixed models to calculate adjusted mean height SDS. RESULTS Mean adjusted height post-KT was -1.77 SDS. Height SDS was within normal range in 55%, whereas 28% showed moderate, and 17% severe growth deficit. Girls were significantly shorter than boys, but catch-up growth by 5 years post-KT was observed in both boys and girls. Children <6 years were shortest at KT and showed the greatest increase in height, whereas there was no catch-up growth in children transplanted >12. CONCLUSIONS Catch-up growth post-KT remains limited, height SDS did not improve over time, resulting in short stature in nearly half of transplanted children in Europe.
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Hirata Y, Sanada Y, Omameuda T, Katano T, Miyahara G, Yamada N, Okada N, Onishi Y, Sakuma Y, Sata N. Liver Transplant for Posthepatectomy Liver Failure in Hepatoblastoma. EXP CLIN TRANSPLANT 2020; 18:612-617. [PMID: 32799783 DOI: 10.6002/ect.2019.0323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Predicting the risk of posthepatectomy liver failure is important when performing extended hepatectomy. However, there is no established method to evaluate liver function and improve preoperative liver function in pediatric patients. MATERIALS AND METHODS We show the clinical features of pediatric patients who underwent living donor liver transplant for posthepatectomy liver failure in hepatoblastoma. The subjects were 4 patients with hepatoblastoma who were classified as Pretreatment Extent of Disease III, 2 of whom had distal metastasis (chest wall and lung). RESULTS Hepatic right trisegmentectomy was performed in 3 patients and extended left hepatectomy in 1 patient. The median alpha-fetoprotein level at the diagnosis of hepatoblastoma was 986300 ng/mL (range, 22500-2726350 ng/mL), and the median alpha-fetoprotein level before hepatectomy was 8489 ng/mL (range, 23-22500 ng/mL). The remnant liver volume after hepatectomy was 33.3% (range, 20% to 34.9%). Four patients had cholangitis after hepatectomy and progressed to posthepatectomy liver failure. The peak serum total bilirubin after hepatectomy was 11.4 mg/dL (range, 8.7-14.6 mg/dL). Living donor liver transplant was performed for these 4 patients with posthepatectomy liver failure, and they did not have a recurrence. CONCLUSIONS When the predictive remnant liver volume by computed tomography-volumetry before extended hepatectomy for patients with hepatoblastoma is less than 40%, the possibility of posthepatectomy liver failure should be recognized.
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Affiliation(s)
- Yuta Hirata
- >From the Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
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Prada Rico M, Fernandez Hernandez M, Castellanos MC, Prado Agredo OL, Pedraza Carvajal A, González Chaparro LE, Gastelbondo Amaya R, Benavides Viveros CA. Growth characterization in a cohort of renal allograft recipients. Pediatr Transplant 2020; 24:e13632. [PMID: 31833221 DOI: 10.1111/petr.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/30/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Growth retardation is a common problem in children with CKD. This study aims to describe growth, prevalence of short stature before RTx, catch-up growth after RTx, and associated factors. METHODS We retrospectively reviewed 74 renal allograft recipients who underwent RTx at Fundación Cardioinfantil, Colombia, between January 2008 and September 2016 with follow-up for 2 years afterwards. Pre-RTx Height_SDS and demographic characteristics were compared between children with normal and short stature. Post-RTx Height_SDS at 1 and 2 years post-RTx and FAH, when available, were retrieved. Children were classified into catch-up growth and no catch-up growth groups depending on whether or not Height_SDS increased ≥0.5 per year within the first 2 years post-RTx. Possible associated factors were compared. RESULTS Seventy-four patients were included. Mean age at RTx was 11 ± 4.0 years, and 43.2% (32/74) were females. Mean Height_SDS for the entire study population at pre-RTx was -2.8 ± 1.5. Before RTx, 68.9% (51/74) had short stature, and 44.6% (33/74) had severe short stature. 37.2% presented catch-up growth post-RTx. Time on dialysis was associated with short pre-RTx stature (OR 1.66; 95% CI [1.15-2.39]; P = .006) and catch-up growth (OR 2.15; 95% CI [1.15-3.99]; P = .016). 44.59% (33/74) reached FAH, and 48.4% (16/33) presented short FAH. CONCLUSIONS Growth continues to be suboptimal after RTx. Given that pre-RTx height is a significantly associated factor, it is important to plan early interventions in terms of growth improvement in these children.
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Affiliation(s)
- Mayerly Prada Rico
- Pediatric Nephrology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Monica Fernandez Hernandez
- Pediatric Endocrinology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Marcela C Castellanos
- Pediatric Nephrology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Olga L Prado Agredo
- Pediatric Nephrology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Alejandra Pedraza Carvajal
- Pediatric Kidney Transplant Division, Kidney Transplant Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Luz E González Chaparro
- Pediatric Nephrology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Ricardo Gastelbondo Amaya
- Pediatric Nephrology Division, Pediatrics Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
| | - Carlos A Benavides Viveros
- Pediatric Kidney Transplant Division, Kidney Transplant Department, Fundación Cardio-infantil, Bogotá, Cundinamarca, Colombia
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Lopez-Gonzalez M, Munoz M, Perez-Beltran V, Cruz A, Gander R, Ariceta G. Linear Growth in Pediatric Kidney Transplant Population. Front Pediatr 2020; 8:569616. [PMID: 33364221 PMCID: PMC7752780 DOI: 10.3389/fped.2020.569616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Growth retardation is one of the main complications of chronic kidney disease (CKD) in children and induces a negative impact on quality of life. Materials and Methods: Retrospective analysis of all consecutive patients younger than 18 years old who received a first KT in our center between 2008 and 2018. Results: 95 first KT recipients, median age at KT of 7.83 years. At the time of KT, 65.52% of males and 54.05% females showed normal height. After transplantation, linear growth improved from -1.53 at transplant to -1.37 SDS height at the last visit. We detected a different linear growth pattern according to patient age at KT. Children younger than 3 years old exhibited the most significant growth retardation at baseline and the greatest linear growth over time (-2.29 vs. -1.82 SDS height), whereas catch-up was not observed in older patients. Multivariate analysis showed that use of corticosteroids was negatively related to SDS height at 1 year after transplantation and final SDS height only was positively associated with SDS height at KT. 44.2 and 22.1% patients received rhGH treatment before and after KT. 71.88% patients reached adulthood with normal final height. Conclusions: In our study, pediatric KT recipients exhibited a normal height in more than half of cases at KT and in more than two thirds at the final adult height. Only children younger than 6 years old presented a relevant growth catch-up after KT. Treatment with rhGH was used before and after KT with significant improvement in height.
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Affiliation(s)
| | - Marina Munoz
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Victor Perez-Beltran
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Alejandro Cruz
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Romy Gander
- Pediatric Urology and Renal Transplant Unit, Department of Pediatric Surgery, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Pediatrics, University Autonomous of Barcelona, Barcelona, Spain
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Behnisch R, Kirchner M, Anarat A, Bacchetta J, Shroff R, Bilginer Y, Mir S, Caliskan S, Paripovic D, Harambat J, Mencarelli F, Büscher R, Arbeiter K, Soylemezoglu O, Zaloszyc A, Zurowska A, Melk A, Querfeld U, Schaefer F. Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study. Front Pediatr 2019; 7:278. [PMID: 31334210 PMCID: PMC6625460 DOI: 10.3389/fped.2019.00278] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022] Open
Abstract
Failure of statural growth is one of the major long-term sequelae of chronic kidney disease (CKD) in children. In recent years effective therapeutic strategies have become available that lead to evidence based practice recommendations. To assess the current growth performance of European children and adolescents with CKD, we analyzed a cohort of 594 patients from 12 European countries who were followed prospectively for up to 6 years in the 4C Study. While all patients were on conservative treatment with a mean estimated glomerular filtration rate of 28 ml/min/1.73 m2 at study entry, 130 children commenced dialysis during the observation period. At time of enrolment the mean height standard deviation score (SDS) was -1.57; 36% of patients had a height below the third percentile. The prevalence of growth failure varied between countries from 7 to 44% Whereas patients on conservative treatment showed stable growth, height SDS gradually declined on those on dialysis. Parental height, pubertal status and treatment with recombinant growth hormone (GH) were positively, and the diagnosis of syndromic disease and CKD stage were negatively associated with height SDS during the observation period. Unexpectedly, higher body mass index (BMI) SDS was associated with lower height SDS both at enrolment and during follow up. Renal anemia, metabolic acidosis, and hyperparathyroidism were mostly mild and not predictive of growth rates by multivariable analysis. GH therapy was applied in only 15% of growth retarded patients with large variation between countries. When adjusting for all significant covariates listed above, the country of residence remained a highly significant predictor of overall growth performance. In conclusion, growth failure remains common in European children with CKD, despite improved general management of CKD complications. The widespread underutilization of GH, an approved efficacious therapy for CKD-associated growth failure, deserves further exploration.
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Affiliation(s)
- Rouven Behnisch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Ali Anarat
- Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Turkey
| | - Justine Bacchetta
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Rukshana Shroff
- Division of Pediatric Nephrology, Great Ormond Street Hospital, London, United Kingdom
| | - Yelda Bilginer
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Mir
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Salim Caliskan
- Division of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Dusan Paripovic
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Jerome Harambat
- Pediatric Nephrology Unit, Bordeaux University Hospital, INSERM Unité Mixte de Recherche, Bordeaux, France
| | - Francesca Mencarelli
- Pediatric Nephrology Unit, Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Rainer Büscher
- Pediatric Nephrology, University Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Klaus Arbeiter
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Oguz Soylemezoglu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Aleksandra Zurowska
- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany
| | - Uwe Querfeld
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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Hussein R, Alvarez-Elías AC, Topping A, Raimann JG, Filler G, Yousif D, Kotanko P, Usvyat LA, Medeiros M, Pecoits-Filho R, Canaud B, Stuard S, Xiaoqi X, Etter M, Díaz-González de Ferris ME. A Cross-Sectional Study of Growth and Metabolic Bone Disease in a Pediatric Global Cohort Undergoing Chronic Hemodialysis. J Pediatr 2018; 202:171-178.e3. [PMID: 30268401 DOI: 10.1016/j.jpeds.2018.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/27/2018] [Accepted: 05/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We sought to assess worldwide differences among pediatric patients undergoing hemodialysis. Because practices differ widely regarding nutritional resources, treatment practice, and access to renal replacement therapy, investigators from the Pediatric Investigation and Close Collaboration to examine Ongoing Life Outcomes, the pediatric subset of the MONitoring Dialysis Outcomes Cohort (PICCOLO MONDO) performed this cross-sectional study. We hypothesized that growth would be better in developed countries, possibly at the expense of bone mineral disease. STUDY DESIGN In this cross-sectional study, we analyzed growth by height z score and recommended age-specific bone mineral metabolism markers from 225 patients <18 years of age maintained on hemodialysis, between the years of 2000 to 2012 from 21 countries in different regions. RESULTS The patients' median age was 16 (IQR 14-17) years, and 45% were females. A height z score less than the third percentile was noted in 34% of the cohort, whereas >66% of patients reported normal heights, with patients from North America having the greatest proportion (>80%). More than 70% of the entire cohort had greater than the age-recommended levels of phosphorus, particularly in the Asia-Pacific and North America, where we also observed the greatest body mass index z score (0.99 ± 1.6) and parathyroid hormone levels (557.1 [268.4-740.5]). Below-recommended parathyroid hormone levels were noted in 26% and elevated levels in 61% of the entire sample, particularly in the Asia Pacific region. Lower-than-recommended calcium levels were noted in 36% of the entire cohort, particularly in Latin America. CONCLUSIONS We found regional differences in growth- and age-adjusted bone mineral metabolism markers. Children from North America had the best growth, received the most dialysis, but also had the worst phosphate control and body mass index z scores.
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Affiliation(s)
- Rasha Hussein
- Brazil Unidad de Investigación y Diagnóstico en Nefrología, Pontificia Universidade Católica do Parana, Curitiba, Paraná, Brazil
| | - Ana Catalina Alvarez-Elías
- Department of Pediatrics, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; SickKids, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alice Topping
- Research Division, Renal Research Institute, New York, NY
| | | | - Guido Filler
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Dalia Yousif
- Department of Pediatrics, Soba University Hospital, Khartoum, Sudan
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY; Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY
| | - Len A Usvyat
- Fresenius Medical Care of North America, Waltham, MA
| | - Mara Medeiros
- Department of Pediatrics, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Departamento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, CDMX, Mexico
| | - Roberto Pecoits-Filho
- Brazil Unidad de Investigación y Diagnóstico en Nefrología, Pontificia Universidade Católica do Parana, Curitiba, Paraná, Brazil
| | - Bernard Canaud
- Fresenius Medical Care Europe, Bad Homburg v.d.H., Germany
| | - Stefano Stuard
- Fresenius Medical Care Europe, Bad Homburg v.d.H., Germany
| | - Xu Xiaoqi
- Fresenius Medical Care Asia Pacific, Wanchai, Hong Kong
| | - Michael Etter
- Fresenius Medical Care Asia Pacific, Wanchai, Hong Kong
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15
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Abstract
Optimal care of the pediatric end-stage renal disease (ESRD) patient on chronic dialysis is complex and requires multidisciplinary care as well as patient/caregiver involvement. The dialysis team, along with the family and patient, should all play a role in choosing the dialysis modality which best meets the patient's needs, taking into account special considerations and management issues that may be particularly pertinent to children who receive peritoneal dialysis or hemodialysis. Meticulous attention to dialysis adequacy in terms of solute and fluid removal, as well as to a variety of clinical manifestations of ESRD, including anemia, growth and nutrition, chronic kidney disease-mineral bone disorder, cardiovascular health, and neurocognitive development, is essential. This review highlights current recommendations and advances in the care of children on dialysis with a particular focus on preventive measures to minimize ESRD-associated morbidity and mortality. Advances in dialysis care and prevention of complications related to ESRD and dialysis have led to better survival for pediatric patients on dialysis.
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16
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Akchurin OM, Kogon AJ, Kumar J, Sethna CB, Hammad HT, Christos PJ, Mahan JD, Greenbaum LA, Woroniecki R. Approach to growth hormone therapy in children with chronic kidney disease varies across North America: the Midwest Pediatric Nephrology Consortium report. BMC Nephrol 2017; 18:181. [PMID: 28558814 PMCID: PMC5450116 DOI: 10.1186/s12882-017-0599-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background Growth impairment remains common in children with chronic kidney disease (CKD). Available literature indicates low level of recombinant human growth hormone (rhGH) utilization in short children with CKD. Despite efforts at consensus guidelines, lack of high-level evidence continues to complicate rhGH therapy decision-making and the level of practice variability in rhGH treatment by pediatric nephrologists is unknown. Methods Cross-sectional online survey electronically distributed to pediatric nephrologists through the Midwest Pediatric Nephrology Consortium and American Society of Pediatric Nephrology. Results Seventy three pediatric nephrologists completed the survey. While the majority (52.1%) rarely involve endocrinology in rhGH management, 26.8% reported that endocrinology managed most aspects of rhGH treatment in their centers. The majority of centers (68.5%) have a dedicated renal dietitian, but 20.6% reported the nephrologist as the primary source of nutritional support for children with CKD. Children with growth failure did not receive rhGH most commonly because of family refusal. Differences in initial work-up for rhGH therapy include variable use of bone age (95%), thyroid function (58%), insulin-like growth factor-1 (40%), hip/knee X-ray (36%), and ophthalmologic evaluation (7%). Most pediatric nephrologists (95%) believe that rhGH treatment improves quality of life, but only 24% believe that it improves physical function; 44% indicated that rhGH improves lean body mass. Conclusions There is substantial variation in pediatric nephrology practice in addressing short stature and rhGH utilization in children with CKD. Hence, there may be opportunities to standardize care to study and improve growth outcomes in short children with CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0599-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Amy J Kogon
- Ohio State University / Nationwide Children's Hospital, Columbus, USA
| | | | - Christine B Sethna
- Hofstra Northwell School of Medicine / Cohen Children's Medical Center of New York, Hempstead, USA
| | | | | | - John D Mahan
- Ohio State University / Nationwide Children's Hospital, Columbus, USA
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17
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Harambat J, Bonthuis M, Groothoff JW, Schaefer F, Tizard EJ, Verrina E, van Stralen KJ, Jager KJ. Lessons learned from the ESPN/ERA-EDTA Registry. Pediatr Nephrol 2016; 31:2055-64. [PMID: 26498279 DOI: 10.1007/s00467-015-3238-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 01/10/2023]
Abstract
End-stage renal disease (ESRD) in children is a medically challenging condition. Due to its rarity and special features, methodologically sound collaborative studies are required. In 2007, a new European registry of pediatric renal replacement therapy (RRT), the ESPN/ERA-EDTA Registry, was launched. In recent years, the Registry has provided comprehensive data on incidence, prevalence, patient characteristics, RRT modalities, and mortality in pediatric ESRD, along with relevant insights into cardiovascular risk, anemia, nutrition and growth, transplantation outcomes, and rare diseases. In this review, we describe the study design and structure underlying the ESPN/ERA-EDTA Registry, summarize the major research findings from more than 20 publications, and discuss current limitations and the future challenges to overcome.
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Affiliation(s)
- Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France.
| | - Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Franz Schaefer
- Department of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany
| | - E Jane Tizard
- Department of Pediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Enrico Verrina
- Dialysis Unit, Gaslini Children's Hospital, Genoa, Italy
| | - Karlijn J van Stralen
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, Netherlands
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, Netherlands
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18
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Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 2016; 31:1579-91. [PMID: 26310616 PMCID: PMC4995226 DOI: 10.1007/s00467-015-3186-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022]
Abstract
Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Dobrowolski LC, van Huis M, van der Lee JH, Peters Sengers H, Liliën MR, Cransberg K, Cornelissen M, Bouts AH, de Fijter JW, Berger SP, van Zuilen A, Nurmohamed SA, Betjes MH, Hilbrands L, Hoitsma AJ, Bemelman FJ, Krediet P, Groothoff JW. Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands. Nephrol Dial Transplant 2016; 31:1947-1956. [DOI: 10.1093/ndt/gfw225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 12/16/2022] Open
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