Advertisement

Pediatric Nephrology

, Volume 22, Issue 8, pp 1189–1193 | Cite as

Early erythropoietin therapy is associated with improved growth in children with chronic kidney disease

  • Michael Boehm
  • Andrea Riesenhuber
  • Wolfgang C. Winkelmayer
  • Klaus Arbeiter
  • Thomas Mueller
  • Christoph AufrichtEmail author
Original Article

Abstract

Recent registry reports related short stature at the time of dialysis initiation to increased morbidity and mortality. Growth may therefore serve as an overall indicator of disease severity and therapy quality in pediatric chronic kidney disease. We studied whether early correction of uremic complications such as anemia was associated with growth failure. In this retrospective cohort study, we assessed demographic, diagnostic, and therapeutic variables at first referral and at dialysis initiation in all children with congenital renal diseases who initiated chronic dialysis at our clinic between 1994–2004. Outcomes were indicators of growth at referral and first dialysis as well as interval growth. Correlation and logistic regression techniques were used for analysis. We studied 47 children (24 boys, 23 girls) who were 7.1 years of age and had a mean glomerular filtration rate (GFR) of 25 ml/min per 1.73 m2 at first visit. Time to dialysis was a median 2.5 years. At first referral, 36% of children had severe growth failure with standard deviation score (SDS) height < −2. Stature at that time point was correlated with GFR (rho = 0.37, p = 0.03) and predicted stature at dialysis initiation (rho = 0.81, p < 0.001). Catch-up growth during predialysis care was achieved in 40% of the children and independently associated with both hemoglobin (OR = 1.85, p = 0.04) and erythropoietin therapy (OR = 13.6, p < 0.05) at first referral. This study confirms the disappointingly high prevalence of growth retardation in children with chronic kidney disease. Initial hemoglobin and early erythropoietin prescription were the only (modifiable) variables associated with improved growth. Almost two thirds of referred children, however, experienced no catch-up growth during follow-up. Further study is needed to better define the optimal timing and intensity of nephrologist care in children with kidney disease.

Keywords

Chronic kidney disease Growth Body stature Hemoglobin Erythropoietin 

Notes

Acknowledgements

This work was partially funded by Austrian Society of Nephrology (OEGN).

References

  1. 1.
    Levin A (2000) Consequences of late referral on patient outcomes. Nephrol Dial Transplant 15:8–13PubMedGoogle Scholar
  2. 2.
    Jungers P (2002) Late referral: loss of chance for the patient, loss of money for society. Nephrol Dial Transplant 17:371–375PubMedCrossRefGoogle Scholar
  3. 3.
    Powe NR (2003) Early referral in chronic kidney disease: an enormous opportunity for prevention. Am J Kidney Dis 41:505–507PubMedCrossRefGoogle Scholar
  4. 4.
    Stack AG (2003) Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis 41:310–318PubMedCrossRefGoogle Scholar
  5. 5.
    Warady BA, Ho M (2003) Morbidity and mortality in children with anemia at initiation of dialysis. Pediatr Nephrol 18:1055–1062PubMedCrossRefGoogle Scholar
  6. 6.
    Wong CS, Gipson DS, Gillen DL, Emerson S, Koepsell T, Sherrard DJ, Watkins SL, Stehman-Breen C (2000) Anthropometric measures and risk of death in children with end-stage renal disease. Am J Kidney Dis 36:811–819PubMedGoogle Scholar
  7. 7.
    Furth SL, Stablein D, Fine RN, Powe NR, Fivush BA (2002) Adverse clinical outcomes associated with short stature at dialysis initiation: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 109:909–913PubMedCrossRefGoogle Scholar
  8. 8.
    Furth SL, Hwang W, Yang C, Neu AM, Fivush BA, Powe NR (2002) Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr Nephrol 17:450–455PubMedCrossRefGoogle Scholar
  9. 9.
    Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799PubMedCrossRefGoogle Scholar
  10. 10.
    Seikaly MG, Ho PL, Emmett L, Fine RN, Tejani A (2003) Chronic renal insufficiency in children: the 2001 Annual Report of the NAPRTCS. Pediatr Nephrol 18:796–804PubMedCrossRefGoogle Scholar
  11. 11.
    Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F; ItalKid Project (2003) Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 111:382–387CrossRefGoogle Scholar
  12. 12.
    Esbjorner E, Berg U, Hansson S (1997) Epidemiology of chronic renal failure in children: a report from Sweden 1986–1994. Swedish Pediatric Nephrology Association. Pediatr Nephrol 11:438–442PubMedCrossRefGoogle Scholar
  13. 13.
    Khan SS, Xue JL, Kazmi WH, Gilbertson DT, Obrador GT, Pereira BJG, Collins AJ (2005) Does predialysis nephrology care influence patient survival after initiation of dialysis? Kidney Int 67:1038–1046PubMedCrossRefGoogle Scholar
  14. 14.
    Valderrabano F, Golper T, Muirhead N, Ritz E, Levin A (2001) Chronic kidney disease: why is current management uncoordinated and suboptimal? Nephrol Dial Transplant 16:S61–S64CrossRefGoogle Scholar
  15. 15.
    Kramar R, Stummvoll HK (2003) Austrian dialysis and transplantation registry (OEDTR). Annual Report, Austrian Society of NephrologyGoogle Scholar
  16. 16.
    Winkelmayer WC, Owen WF, Levin R, Avorn J (2003) Aprospensity analysis of late vs. early nephrologist referral and mortality on dialysis. J Am Soc Nephrol 14:486–492PubMedCrossRefGoogle Scholar
  17. 17.
    Van Damme-Lombaerts R, Herman J (1999) Erythropoietin treatment in children with renal failure. Pediatric Nephrol 13:148–152CrossRefGoogle Scholar
  18. 18.
    Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC (2004) Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int 66:753–760PubMedCrossRefGoogle Scholar
  19. 19.
    Leavy SF, Strawderman RL, Jones CA, Port FK, Held PJ (1998) Simple nutrional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 31:997–1006Google Scholar

Copyright information

© IPNA 2007

Authors and Affiliations

  • Michael Boehm
    • 1
  • Andrea Riesenhuber
    • 1
  • Wolfgang C. Winkelmayer
    • 2
  • Klaus Arbeiter
    • 1
  • Thomas Mueller
    • 1
  • Christoph Aufricht
    • 1
    • 3
    Email author
  1. 1.Kinderdialyse, Department of PediatricsMedical University ViennaViennaAustria
  2. 2.Division of Pharmacoepidemiology and Pharmacoeconomics and Renal Division, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.KinderdialyseUniversitaetsklinik fuer Kinder- und JugendheilkundeViennaAustria

Personalised recommendations