Assessment of growth retardation in children on renal replacement therapy from 2000 to 2016 – one center experience
Katarzyna Zachwieja 1  
,   Dorota Drożdż 1  
,   Joanna Hubert 2  
,   Natalia Dudek 3  
,   Anna Moczulska 1  
,   Monika MIklaszewska 1  
,   Jacek A. Pietrzyk 1  
 
More details
Hide details
1
Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków
2
Cardiff and Vale University Health Board, University Hospital of Wales
3
Kliniczny Szpital Wojewódzki Nr 2 im. Św. Jadwigi Królowej w Rzeszowie
CORRESPONDING AUTHOR
Katarzyna Zachwieja   

Department of Pediatric Nephrology, Jagiellonian University Medical College, Kraków, ul. Wielicka 265, 30-663 Kraków
 
Ann. Acad. Med. Siles. 2017;71:122–128
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The aim of the study was to assess the growth in children on RRT during the period 2000–2016.

Material and methods:
The diagnosis, comorbidity, RRT data, patient outcome and growth hormone (GH) usage (in 102 patients) and height Z score for 87 patients at the start of RRT and for 94 patients at the end of RRT were analyzed.

Results:
In 60% of patients, peritoneal dialysis was the first method, in 38% hemodialysis and in 2% a preemptive transplantation was performed. The average dialysis time was 34.6 months (1–136 months) and it was statistically longer in the years 2000–2008 than in 2009–2016 (av. 43.3 ± 32.7 months vs 18.3 ± 13.1; p = 0.00005). In the group with comorbidity (46% patients) Z score 0 (start) and Z score 1 (the end) were lower than in the group without comorbidity (average Z score 0: -2.3 ± 2.3 vs -1.08 ± 1.6; p = 0.003) and the dialysis time was also longer (p = 0.02). The Z score in all the patients at the start of RRT was -1.7 ± 2.0 (min: -9.3 to max: +2.0) and there was no statistical dif-ference in comparison to the Z score at the end of RRT: Z score 1; p = 0.37. A Z score < -2.0 was found in 42.5% of children at the start and in 45% at the end of RRT. In 17% of the GH treated group, growth improvement was shown by no difference in Z score 1 in comparison to the group without GH therapy.

Conclusions:
Short stature is still a problem in children on dialysis. Comorbidity is important factor of growth retardation. GH therapy is effective in children on RRT.

 
REFERENCES (23)
1.
Rodig N.M., Mc Dermott K.C., Schneider M.F., Hotchkiss H.M., Yadin O., Seikaly M.G., Furth S.L., Warady B.A. Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study. Pediatr. Nephrol. 2014; 29: 1987–1995.
 
2.
Harambat J., Bonthuis M., van Stralen K.J., Ariceta G., Battelino N., Bjerre A., Jahnukainen T., Leroy V., Reusz G., Sandes A.R., Sinha M.D., Groothoff J.W., Combe C., Jager K.J., Verrina E. Schaefer F ESPN/ERA-EDTA Registry. Adult height in patients with advanced CKD requiring renal replacement therapy during childhood. Clin. J. Am. Soc. Nephrol. 2014; 9: 92–99.
 
3.
Van Huis M., Bonthuis M., Sahpazova E., Mencarelli F., Spasojević B., Reusz G., Caldas-Afonso A., Bjerre A., Baiko S., Vondrak K., Molchanova E.A., Kolvek G., Zaikova N., Böhm M., Ariceta G., Jager K.J., Schaefer F., van Stralen K.J., Groothoff J.W. Considerable variations in growth hormone policy and prescription in pediatric end-stage renal disease across European countries – a report from the ESPN/ERA-EDTA registry. Nephrol. Dial. Tranplant. 2016; 31: 609–619.
 
4.
Guthrie L.G. Chronic interstitial nephritis in childhood. Lancet. 1897; 149: 585.
 
5.
Rees L. Growth hormone therapy in children with CKD after more than two decades of practice. Pediatr. Nephrol. 2016; 31: 1421–1435.
 
6.
Sieniawska M., Pańczyk-Tomaszewska M., Ziółkowska H., Jędrzejow-ski A., Leszczyńska B., Dyras P., Kałużyńska A., Makulska I., Pietrzyk J.A., Rubik J., Siteń G., Stachowski J., Szprynger K., Żurowska A., Roszkowska-Blaim M. Wyniki leczenia rekombinowanym hormonem wzrostu niskorosłości dzieci ze schyłkową niewydolnością nerek. Pol. Merkuriusz Lek. 2001; 10: 263–266.
 
7.
Fine R.N., Martz K., Stablein D. 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. 2010; 25: 739–746.
 
8.
Hartung E.A., Furth S.L. Growth in children on renal replacement therapy: a shrinking problem? Pediatr. Nephrol. 2013; 28: 1905–1908.
 
9.
Fischbach M., Terzic J., Menouer S., Dheu C., Seuge L., Zalosczic A. Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol. Dial. Transpl. 2010; 25: 867–873.
 
10.
Goldstein S.L., Silverstein D.M., Leung J.C., Feig D.I., Soletsky B., Knight C., Warady B.A. Frequent hemodialysis with NxStageTM system in pediatric patients receiving maintenance hemodialysis. Pediatr. Nephrol. 2008; 23: 129–135.
 
11.
Warady B.A., Neu A.M., Schaefer F. Optimal Care of the Infant, Child, and Adolescent on Dialysis: 2014 Update. Am. J. Kidney Dis. 2014; 64: 128–142.
 
12.
Mekahli D., Ledermann S., Gullett A., Rees L. Evaluation of quality of life by young adult survivors of severe chronic kidney disease in infancy. Pediatr. Nephrol. 2014; 29: 1387–1393.
 
13.
Al-Uzri A., Matheson M., Gipson D.S., Mendley S.R., Hooper S.R., Yadin O., Rozansky D.J., Moxey-Mims M., Furth S.L., Warady B.A., Gerson A.C. The impact of short stature on health-related quality of life in children with chronic kidney disease. J. Pediatr. 2013; 163: 736–741.
 
14.
Furth S.L., Hwang W., Yang C., Neu A.M., Fivush B.A., Powe N.R. Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr. Nephrol. 2002; 17: 450–455.
 
15.
Wong C.S., Gipson D.S., Gillen D.L., Emerson S., Koepsell T., Sherrard D.J., Watkins S.L., Stehman-Breen C. Anthropometric measures and risk of death in children with end-stage renal disease. Am. J. Kidney Dis. 2000; 36: 811–819.
 
16.
Salević P., Radović P., Milić N., Bogdanović R., Paripović D., Paripović A., Golubović E., Milosević B., Mulić B., Peco-Antić A. Growth in children with chronic kidney disease: 13 years follow up study. J. Nephrol. 2014; 27: 537–544.
 
17.
Franke D., Winkel S., Gellermann J., Querfeld U., Pape L., Ehrich J.H., Haffner D., Pavičić L., Zivičnjak M. Growth and maturation improvement in children on renal replacement therapy over the past 20 years. Pediatr. Nephrol. 2013; 28: 2043–2051.
 
18.
U.S. Renal Data System USRDS 2012 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Washington DC. Available at: http://www.usrds.org/atlas12.a... [dostęp: styczeń 2017].
 
19.
http://pedpd.org/ [dostęp: styczeń 2017].
 
20.
Ziółkowska H., Roszkowska-Blaim M., Skrzypczyk P., Adamczuk D., Majcher A., Bałasz-Chmielewska I., Zachwieja K., Szczepańska M., Kału-żyńska A., Bednorz R., Zachwieja J., Siteń G., Grenda R., Pacanowska B., Kipigroch H., Borzęcka H., Zoch-Zwierz W., Pałuba E. Leczenie rekombi-nowanym ludzkim hormonem wzrostu niskorosłych dzieci z przewlekłą chorobą nerek w Polsce (1994–2008). Nowa Pediatria 2008; 2, 28–34.
 
21.
Pruthi R., Maxwell H., Casula A., Braddon F., Lewis M., O'Brien C., Stojanovic J., Tse Y., Inward C., Sinha M.D. Renal Registry 16th annual report: chapter 13 clinical, haematological and biochemical parameters in patients receiving renal replacement therapy in paediatric centres in the UK in 2012: national and centre-specific analyses. Nephron. Clin. Pract. 2013; 125: 259–273.
 
22.
Szczepańska M., Broll I., Dymon I., Szprynger K. Ocena wyników leczenia hormonem wzrostu z dzieci z przewlekłą niewydolnością nerek – doświadczenia jednego ośrodka. Pol. Merk. Lek. 2008; supl.4: 46–50.
 
23.
Seikaly M.G., Salhab N., Gipson D., Yiu.V., Stablein D. Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr. Nephrol. 2006; 21: 793–799.
 
eISSN:1734-025X