Growth in children on kidney replacement therapy: a review of data from patient registries

Marjolein Bonthuis,Jérôme Harambat,Kitty J Jager,Enrico Vidal

doi:10.1007/s00467-021-05099-4

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.

Highlights

Chronic kidney disease (CKD) has wide-ranging and longterm consequences for children and their families, including growth retardation, which is a marker of disease severity
Clinical and experimental evidence demonstrates that perturbations in the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis are responsible for many important complications seen in CKD, such as growth retardation and protein energy wasting, as well as disease progression [1, 3, 4]
The European Society of Paediatric Nephrology (ESPN)/ERA-EDTA Registry showed no secular trends in growth post transplantation in European children between 1990 and 2012 according to the period of kidney transplantation (KT), suggesting that the improvement of final height over time is most likely explained by better pre-CKD 5 care [25]

Summary

Introduction

Chronic kidney disease (CKD) has wide-ranging and longterm consequences for children and their families, including growth retardation, which is a marker of disease severity. Clinical and experimental evidence demonstrates that perturbations in the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis are responsible for many important complications seen in CKD, such as growth retardation and protein energy wasting, as well as disease progression [1, 3, 4] These alterations include changes in the 24-h levels of spontaneous GH release, reduced GH receptor density in target organs, and disturbed cascade of intracellular signaling events (post-receptor defect). The ESPN/ERA-EDTA Registry showed no secular trends in growth post transplantation in European children between 1990 and 2012 according to the period of KT, suggesting that the improvement of final height over time is most likely explained by better pre-CKD 5 care [25]. Given the strong association between growth, clinical outcomes, and quality of life in children

Result

Female

Findings

Which statement about growth in pediatric KRT patients is correct?