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Longitudinal outcomes of body mass index in overweight and obese children with chronic kidney disease

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Abstract

Background

Longitudinal changes in body mass index (BMI) among overweight and obese children with chronic kidney disease (CKD) are not well characterized. We studied longitudinal trajectories and correlates of these trajectories, as results may identify opportunities to optimize health outcomes.

Methods

Longitudinal changes in age-sex-specific BMI z-scores over 1851 person-years of follow-up were assessed in 524 participants of the Chronic Kidney Disease in Children Study. A total of 353 participants were categorized as normal (BMI > 5th to < 85th percentile), 56 overweight (BMI ≥ 85th to 95th percentile) and 115 obese (BMI ≥ 95th percentile) based on the average of three BMI measurements during the first year of follow-up. Studied covariates included age, sex, race, CKD etiology, corticosteroid usage, household income, and maternal education.

Results

In unadjusted analysis, BMI z-scores decreased over time in elevated BMI groups (overweight: mean = − 0.06 standard deviations (SD) per year, 95% CI: − 0.11, − 0.01; obese: mean = − 0.04 SD per year, 95% CI: − 0.07, − 0.01). Among obese children, only age was associated with change in BMI z-score; children < 6 years had a mean decrease of 0.19 SD during follow-up (95% CI: − 0.30, − 0.09). Socioeconomic factors were not associated with change in BMI.

Conclusion

Overweight and obese children with CKD demonstrated a significant annual decline in BMI, though the absolute change was modest. Among obese children, only age < 6 years was associated with significant decline in BMI. Persistence of elevated BMI in older children and adolescents with CKD underscores the need for early prevention and effective intervention.

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in Children (CKiD) study with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri, Kansas (B.W.) and Children’s Hospital of Philadelphia (Susan Furth); central biochemistry laboratory at the University of Rochester Medical Center (George Schwartz); and data coordinating center at the Johns Hopkins Bloomberg School of Public Health (Derek Ng, Alvaro Munõz).

Funding

The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U24-DK-082194, U24-DK-66116). The CKiD website is located at https://statepi.jhsph.edu/ckid.

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Authors and Affiliations

  1. Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Nancy M. Rodig

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer Roem & Michael F. Schneider

  3. Department of Pediatrics, Inova Children’s Hospital and Pediatric Specialists of Virginia, Falls Church, VA, USA

    Patricia W. Seo-Mayer

  4. Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA

    Kimberly J. Reidy & Frederick J. Kaskel

  5. Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Amy J. Kogon & Susan L. Furth

  6. Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

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  1. Nancy M. Rodig
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  2. Jennifer Roem
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  3. Michael F. Schneider
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Contributions

Research idea and study design: NR, JR, MS, BW; data acquisition: JR, MS; data analysis/interpretation: NR, JR, MS, PS, KR, FK, AK, SF, BW; statistical analysis: JR, MS; supervision or mentorship: BW. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Nancy M. Rodig.

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Rodig, N.M., Roem, J., Schneider, M.F. et al. Longitudinal outcomes of body mass index in overweight and obese children with chronic kidney disease. Pediatr Nephrol 36, 1851–1860 (2021). https://doi.org/10.1007/s00467-020-04907-7

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