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. 2024 Oct-Dec;46(4):e20230203.
doi: 10.1590/2175-8239-JBN-2023-0203en.

Growth in children with chronic kidney disease and associated risk factors for short stature

[Article in English, Portuguese]
Virgínia Barbosa de Melo  1 , Danielle Barbosa da Silva  1 , Matheus Dantas Soeiro  2 , Lucas Cavalcante Tenório de Albuquerque  2 , Henderson Edward Firmino Cavalcanti  2 , Marcela Correa Araújo Pandolfi  1 , Rosilene Mota Elias  3 , Rosa Maria Affonso Moysés  4 , Emília Maria Dantas Soeiro  1   5
Affiliations

Growth in children with chronic kidney disease and associated risk factors for short stature

[Article in English, Portuguese]
Virgínia Barbosa de Melo et al. J Bras Nefrol. 2024 Oct-Dec.

Abstract
in English, Portuguese

Introduction: Growth failure in chronic kidney disease is related to high morbidity and mortality. Growth retardation in this disease is multifactorial. Knowing the modifiable factors and establishing strategies to improve care for affected children is paramount.

Objectives: To describe growth patterns in children with chronic kidney disease and the risk factors associated with short stature.

Methods: We retrospectively analyzed anthropometric and epidemiological data, birth weight, prematurity, and bicarbonate, hemoglobin, calcium, phosphate, alkaline phosphatase, and parathormone levels of children with stages 3-5 CKD not on dialysis, followed for at least one year.

Results: We included 43 children, the majority of which were boys (65%). The mean height/length /age z-score of the children at the beginning and follow-up was -1.89 ± 1.84 and -2.4 ± 1.67, respectively (p = 0.011). Fifty-one percent of the children had short stature, and these children were younger than those with adequate stature (p = 0.027). PTH levels at the beginning of the follow-up correlated with height/length/age z-score. A sub-analysis with children under five (n = 17) showed that 10 (58.8%) of them failed to thrive and had a lower weight/age z-score (0.031) and lower BMI/age z-score (p = 0.047).

Conclusion: Children, particularly younger ones, with chronic kidney disease who were not on dialysis had a high prevalence of short stature. PTH levels were correlated with height z-score, and growth failure was associated with worse nutritional status. Therefore, it is essential to monitor the growth of these children, control hyperparathyroidism, and provide nutritional support.

Introdução:: A deficiência de crescimento na doença renal crônica está relacionada à elevada morbidade e mortalidade. O retardo do crescimento nessa doença é multifatorial. É fundamental conhecer os fatores modificáveis e estabelecer estratégias para melhorar o atendimento às crianças afetadas.

Objetivos:: Descrever padrões de crescimento em crianças com DRC e fatores de risco associados à baixa estatura.

Métodos:: Analisamos retrospectivamente dados antropométricos e epidemiológicos, peso ao nascer, prematuridade e níveis de bicarbonato, hemoglobina, cálcio, fosfato, fosfatase alcalina e paratormônio de crianças com DRC estágios 3–5, não submetidas a diálise, acompanhadas por pelo menos um ano.

Resultados:: Incluímos 43 crianças, a maioria meninos (65%). O escore z médio de altura/comprimento/idade das crianças no início e no acompanhamento foi de –1,89 ± 1,84 e –2,4 ± 1,67, respectivamente (p = 0,011). Cinquenta e um por cento das crianças apresentaram baixa estatura, e essas crianças eram mais jovens que aquelas com estatura adequada (p = 0,027). Níveis de PTH no início do acompanhamento correlacionados com escore z de altura/comprimento/idade. Uma subanálise com crianças menores de cinco anos (n = 17) mostrou que 10 (58,8%) delas apresentaram déficit de desenvolvimento e escore z de peso/idade mais baixo (0,031) e escore z de IMC/idade mais baixo (p = 0,047).

Conclusão:: Crianças, especialmente mais jovens, com DRC, que não estavam em diálise, apresentaram elevada prevalência de baixa estatura. Níveis de PTH foram correlacionados com escore z de altura, e deficiência de crescimento foi associada a pior estado nutricional. Portanto, é essencial monitorar o crescimento dessas crianças, controlar o hiperparatireoidismo e fornecer suporte nutricional.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest related to the publication of this manuscript.

Figures

Figure 1
Figure 1. Correlation between initial PTH levels and height/length z-score.
Figura 1
Figura 1. Correlação entre níveis iniciais de PTH e escore z de altura/comprimento.
See this image and copyright information in PMC

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