Linear growth in pediatric hemodialysis patients

Abstract

Growth is an important outcome in pediatric kidney disease. We aimed to identify factors associated with growth in pediatric hemodialysis (HD) patients. Height standard deviation scores (Ht SDS) of pediatric HD patients with consecutive height measurements in the ESRD Clinical Performance Measures Project were calculated. Multiple linear regression determined the effect of factors on Ht SDS change/year. Four hundred and seven patients were included. Median age was 15.2 years (interquartile range 13.2-16.5 years); 44% were girls, and 27% were black. Of patients observed, 66% had growth hormone (GH) data, and of those, 29% were prescribed GH. Mean change in Ht SDS/year was -0.10+/-0.71. After adjustment, decreasing Ht SDS was associated with younger age (-0.2/year for <13 vs. >or=13 years; p<0.0001), longer duration on dialysis (-0.03/year for >or=6 months vs. <6 months; p<0.01), and higher normalized protein catabolic rate (nPCR) (-0.02/year per 0.1; p<0.05). Improved growth was seen in girls (0.10/year; p<0.01) and in those with lower Ht SDS (0.03/year per 0.5 decrease; p<0.001). Hemoglobin, GH use, and adequacy were associated with neither positive nor negative changes in Ht SDS. Growth retardation while on HD was most pronounced in patients who were young, male, had longer durations on HD, had higher nPCR, and had higher baseline Ht SDS.