Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant
Among children who receive a kidney transplant, short stature is associated with a more complicated post-transplant course and increased mortality. Short stature prior to transplant may reflect the accumulated risk of multiple factors during chronic kidney disease (CKD); however, its relationship with post-transplant kidney function has not been well characterized.
In the Chronic Kidney Disease in Children (CKiD) cohort restricted to children who received a kidney transplant, short stature (i.e., growth failure) was defined as age-sex-specific height < 3rd percentile. The outcome was time to estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2 after transplant. Parametric survival models, including adjustment for disease severity, socioeconomic status (SES), and parental height by inverse probability weighting, described the relative times to eGFR< 45 ml/min/1.73 m2.
Of 138 children (median CKD duration at transplant: 13 years), 20% (28) had short stature before the transplant. The median time to eGFR < 45 ml/min/1.73 m2 after kidney transplantation was 6.6 years and those with short stature had a significantly faster time to the poor outcome (log-rank p value 0.004). Children with short stature tended to have lower SES, nephrotic proteinuria, higher blood pressure, and lower mid-parental height before transplant. After adjusting for these variables, children with growth failure had 40% shorter time to eGFR < 45 ml/min/1.73 m2 than those with normal stature (relative time 0.60, 95%CI 0.32, 1.03).
Short stature was associated with a faster time to low kidney function after transplant. SES, disease severity, and parental height partially explained the association. Clinicians should be aware of the implications of growth failure on the outcome of this unique population, while continued attempts are made to define modifiable factors that contribute to this association.
KeywordsKidney transplantation Pediatrics Growth failure GFR Graft loss
Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health.
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, U01DK-082194, U01-DK-66116). Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award number UL1TR002378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The CKiD website is located at http://www.statepi.jhsph.edu/ckid.
Compliance with ethical standards
The study protocol was approved by the institutional review board of each participating center. All participants and their families provided informed consent.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Fine R, Martz K, Stablein D (2010) What have 20 years of data from the North American pediatric renal transplant cooperative study taught us about growth following renal transplantation in infants, children, and adolescents with end-stage renal disease? Pediatr Nephrol 25(4):739–746CrossRefGoogle Scholar
- 9.Abubakar A (2012) Socioeconomic status, anthropometric status and developmental outcomes of East-African children. In: Handbook of anthropometry. 2012th ed. Springer, New York, pp 2679–2693Google Scholar
- 15.Center for Disease Control and Prevention (2000) Clinical Growth Charts. http://www.cdc.gov/growthcharts/. Accessed 13 December 2017
- 17.Pierce CB, Cox C, Saland JM, Furth SL, Muñoz A (2011) Methods for characterizing differences in longitudinal glomerular filtration rate changes between children with glomerular chronic kidney disease and those with nonglomerular chronic kidney disease. Am J Epidemiol 174(5):604–612CrossRefGoogle Scholar
- 25.Hidalgo G, Ng DK, Moxey-Mims M, Minnick ML, Blydt-Hansen T, Warady BA, Furth SL (2013) Association of income level with kidney disease severity and progression among children and adolescents with CKD: a report from the chronic kidney disease in children (CKiD) study. Am J Kidney Dis 62(6):1087–1094CrossRefGoogle Scholar
- 30.Seifert ME, Ashoor IF, Chiang ML, Chishti AS, Dietzen DJ, Gipson DS, Janjua HS, Selewski DT, Hruska KA (2016) Fibroblast growth factor-23 and chronic allograft injury in pediatric renal transplant recipients: a Midwest pediatric nephrology consortium study. Pediatr Transplant 20(3):378–387CrossRefGoogle Scholar
- 33.Van Ree RM, Oterdoom LH, De Vries AP, Gansevoort RT, van der Heide JJ, van Son WJ, Ploeg RJ, de Jong PE, Gans RO, Bakker SJ (2006) Elevated levels of C-reactive protein independently predict accelerated deterioration of graft function in renal transplant recipients. Nephrol Dial Transplant 22(1):246–253CrossRefGoogle Scholar