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Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study

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Abstract

Background

Growth failure is common among children with chronic kidney disease (CKD). We examined the relationship of growth parameters with glomerular filtration rate (GFR), CKD diagnosis, sex and laboratory results in children with CKD.

Methods

Baseline data from 799 children (median age 11.0 years, median GFR 49.9 mL/min/1.73 m2) participating in the Chronic Kidney Disease in Children Study were examined. Growth was quantified by age–sex-specific height, weight, body mass index (BMI–age), and height–age–sex-specific BMI (BMI-height-age) standard deviation scores (SDS).

Results

Median height and weight SDS were −0.55 [interquartile range (IQR) −1.35 to 0.19] and 0.03 (IQR −0.82 to 0.97), respectively. Girls with non-glomerular CKD were the shortest (median height SDS −0.83; IQR −1.62 to −0.02). Compared to those with a serum bicarbonate (CO2) level of ≥22 mEq/L, children with CO2 of <18 mEq/L had a height SDS that was on average 0.67 lower [95 % confidence interval (CI) −0.31 to −1.03]. Only 23 % of children with a height SDS of ≤−1.88 were prescribed growth hormone therapy. Forty-six percent of children with glomerular CKD were overweight or obese (BMI-height-age ≥85th percentile).

Conclusions

Growth outcomes in a contemporary cohort of children with CKD remain suboptimal. Interventions targeting metabolic acidosis and overcoming barriers to recombinant human growth hormone usage may improve growth in this population.

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Acknowledgments

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). The CKID website is located at http://www.statepi.jhsph.edu/ckid.

We would like to acknowledge Dr. Bethany Foster of McGill University Health Centre Research Institute for her generous assistance with the algorithm for calculating height-age–sex-specific BMI SDS.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Nephrology , Harvard Medical School–Children’s Hospital Boston, Boston, MA, 02115, USA

    Nancy M. Rodig

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

    Kelly C. McDermott & Michael F. Schneider

  3. Mount Sinai School of Medicine, New York, NY, USA

    Hilary M. Hotchkiss

  4. University of California Los Angeles, Los Angeles, CA, USA

    Ora Yadin

  5. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Mouin G. Seikaly

  6. The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L. Furth

  7. Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley A. Warady

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  1. Nancy M. Rodig
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Correspondence to Nancy M. Rodig.

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Rodig, N.M., McDermott, K.C., Schneider, M.F. et al. Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study. Pediatr Nephrol 29, 1987–1995 (2014). https://doi.org/10.1007/s00467-014-2812-9

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  • DOI: https://doi.org/10.1007/s00467-014-2812-9

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