Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;38(10):3435-3443.
doi: 10.1007/s00467-023-05973-3. Epub 2023 May 8.

Associations of longitudinal height and weight with clinical outcomes in pediatric kidney replacement therapy: results from the ESPN/ERA Registry

Marjolein Bonthuis  1   2 , Sevcan A Bakkaloglu  3 , Enrico Vidal  4 , Sergey Baiko  5 , Fiona Braddon  6 , Carmela Errichiello  7 , Telma Francisco  8 , Dieter Haffner  9 , Annie Lahoche  10 , Beata Leszczyńska  11 , Jurate Masalkiene  12 , Jelena Stojanovic  13 , Maria S Molchanova  14 , George Reusz  15 , Adela Rodriguez Barba  16 , Alejandra Rosales  17 , Sanja Tegeltija  18 , Elisa Ylinen  19 , Galia Zlatanova  20 , Jérôme Harambat  21 , Kitty J Jager  22   23
Affiliations

Associations of longitudinal height and weight with clinical outcomes in pediatric kidney replacement therapy: results from the ESPN/ERA Registry

Marjolein Bonthuis et al. Pediatr Nephrol. 2023 Oct.

Abstract

Background: Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT.

Methods: We included patients < 20 years starting KRT in 33 European countries from 1995-2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) < -1.88 and tall stature as height SDS > 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates.

Results: We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78-0.86), tall (aHR: 0.65, 95% CI: 0.56-0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71-0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92-2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38-2.23) and obese (aHR: 1.49, 95% CI: 1.11-1.99) patients showed higher all-cause mortality risk than normal weight subjects.

Conclusions: Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Body composition; Children; Growth; Kidney transplantation; Mortality.

PubMed Disclaimer

Conflict of interest statement

We have no conflicts of interest to declare. The results presented in this paper have not been published previously in whole or part, except in abstract form.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Proportion of patients being underweight, normal weight, overweight and obese stratified by stature
Fig. 2
Fig. 2
Forest plots for the associations of height (left panel) and BMI (right panel) categories and all cause, infection related, and cardiovascular mortality. The black and grey diamonds and bars represent the unadjusted and adjusted hazard ratios and 95% confidence intervals, respectively. Adjustments were made for country, sex, age, primary renal disease, and treatment modality. # Number of subjects was too low to obtain any effect estimate. Abbreviations: HR, Hazard ratio; CI, confidence interval; BMI, body mass index
See this image and copyright information in PMC

Comment in

References

    1. Foster BJ, Mitsnefes MM, Dahhou M, Zhang X, Laskin BL. Changes in excess mortality from end stage renal disease in the united states from 1995 to 2013. Clin J Am Soc Nephrol. 2018;13:91–99. doi: 10.2215/CJN.04330417. - DOI - PMC - PubMed
    1. Chesnaye NC, Schaefer F, Groothoff JW, Bonthuis M, Reusz G, Heaf JG, Lewis M, Maurer E, Paripović D, Zagozdzon I, van Stralen KJ, Jager KJ. Mortality risk in European children with end-stage renal disease on dialysis. Kidney Int. 2016;89:1355–1362. doi: 10.1016/j.kint.2016.02.016. - DOI - PubMed
    1. McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350:2654–2662. doi: 10.1056/NEJMoa031643. - DOI - PubMed
    1. Ku E, Glidden DV, Hsu CY, Portale AA, Grimes B, Johansen KL. Association of body mass index with patient-centered outcomes in children with ESRD. J Am Soc Nephrol. 2016;27:551–558. doi: 10.1681/ASN.2015010008. - DOI - PMC - PubMed
    1. Ku E, Fine RN, Hsu CY, McCulloch C, Gidden DV, Grimes B, Johansen KL. Height at first RRT and mortality in children. Clin J Am Soc Nephrol. 2016;11:832–839. doi: 10.2215/CJN.08250815. - DOI - PMC - PubMed

Publication types