Abstract
Growth failure is almost inextricably linked with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Growth failure in CKD has been associated with both increased morbidity and mortality. Growth failure in the setting of kidney disease is multifactorial and is related to poor nutritional status as well as comorbidities, such as anemia, bone and mineral disorders, and alterations in hormonal responses, as well as to aspects of treatment such as steroid exposure. This review covers updated management of growth failure in these children including adequate nutrition, treatment of metabolic alterations, and early administration of recombinant human growth hormone (GH).
Highlights
Growth retardation remains a major problem in patients with chronic kidney disease (CKD)
The United States Renal Data System (USRDS) Pediatric Growth and Development Study showed that children with end-stage renal disease (ESRD) with moderate or severe growth retardation have higher rates of morbidity and mortality than children with normal growth rate [2]
In patients with CKD, the growth spurt is of shorter duration and intensity, causing height gain in this period to be reduced by 45% compared to healthy children
Summary
Growth retardation remains a major problem in patients with chronic kidney disease (CKD). In Chile, according to the National Registry of Chronic Kidney Disease of 2007, approximately 50% of patients with CKD have significant growth retardation This growth delay is progressive, being −0.7 at birth (when they are affected since birth), −1.5 at start of dialysis, and −2.4 SDS at transplant. Most infants with CKD need supplementary feeding to maintain adequate water, electrolytes and nutrient requirements [1] In this regard, patients with CKD in the predialysis stage, supported with early nutritional intervention to prevent metabolic disorders, may achieve adequate growth rates as good as 22.2 cm during the first year, 10.9 cm during the second, and 7.6 cm during the third year of life [9]. In patients with CKD, the growth spurt is of shorter duration and intensity, causing height gain in this period to be reduced by 45% compared to healthy children This pubertal delay is seen in kidney transplant patients. The most important determinant factors on adult height of patients with ESRD are the etiology of the disease, age of onset, and duration of CKD [12]
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