Abstract
Growth failure is a common and significant clinical problem for children on dialysis and often remains a major impediment to their rehabilitation. Early referral to a paediatric nephrology centre and appropriate management before the initiation of dialysis may significantly prevent growth deterioration. Growth in children on dialysis can be affected by nutritional, metabolic, and hormonal changes. Early diagnosis of malnutrition and aggressive management should be a priority. Gastrostomy feeding should be used when adequate oral intake to maintain normal height and weight velocity cannot be achieved. Active vitamin D metabolites should be used carefully, to prevent low-turnover bone disease. All children should have an adequate regimen of dialysis and an appropriate management of malnutrition, renal osteodystrophy, metabolic acidosis, salt wasting and anaemia, before recombinant human growth hormone (rhGH) administration is considered. The current challenge of reversing growth impairment in children on dialysis can only be achieved by optimization of their care.
Highlights
It has long been recognized that growth retardation is a common complication of children on dialysis [1, 2]
Poor growth is unlikely to be the cause of this increased morbidity, growth failure may be a marker of untoward events [3]
Children with extremely short stature face a disability that may affect their psychological and social well-being [5]. In this issue of Pediatric Nephrology Cansick and coworkers report on the growth of 35 prepubertal children who have been on dialysis for more than 1 year [6]
Summary
It has long been recognized that growth retardation is a common complication of children on dialysis [1, 2] This problem remains a concern today, despite the radical improvements in their management over the past two decades. Children with extremely short stature face a disability that may affect their psychological and social well-being [5] In this issue of Pediatric Nephrology Cansick and coworkers report on the growth of 35 prepubertal children who have been on dialysis for more than 1 year [6]. A subset of children on dialysis may still have poor linear growth, despite the optimal management of all the treatable factors For these patients the administration of rhGH is recommended
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