Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study
Failure of statural growth is one of the major long-term sequelae of chronic kidney disease (CKD) in children. In recent years effective therapeutic strategies have become available that lead to evidence based practice recommendations. To assess the current growth performance of European children an...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2019.00278/full |
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| author | Rouven Behnisch Marietta Kirchner Ali Anarat Justine Bacchetta Rukshana Shroff Yelda Bilginer Sevgi Mir Salim Caliskan Dusan Paripovic Jerome Harambat Francesca Mencarelli Rainer Büscher Klaus Arbeiter Oguz Soylemezoglu Ariane Zaloszyc Aleksandra Zurowska Anette Melk Uwe Querfeld Franz Schaefer and the 4C Study Consortium |
| author_facet | Rouven Behnisch Marietta Kirchner Ali Anarat Justine Bacchetta Rukshana Shroff Yelda Bilginer Sevgi Mir Salim Caliskan Dusan Paripovic Jerome Harambat Francesca Mencarelli Rainer Büscher Klaus Arbeiter Oguz Soylemezoglu Ariane Zaloszyc Aleksandra Zurowska Anette Melk Uwe Querfeld Franz Schaefer and the 4C Study Consortium |
| author_sort | Rouven Behnisch |
| collection | DOAJ |
| description | Failure of statural growth is one of the major long-term sequelae of chronic kidney disease (CKD) in children. In recent years effective therapeutic strategies have become available that lead to evidence based practice recommendations. To assess the current growth performance of European children and adolescents with CKD, we analyzed a cohort of 594 patients from 12 European countries who were followed prospectively for up to 6 years in the 4C Study. While all patients were on conservative treatment with a mean estimated glomerular filtration rate of 28 ml/min/1.73 m2 at study entry, 130 children commenced dialysis during the observation period. At time of enrolment the mean height standard deviation score (SDS) was −1.57; 36% of patients had a height below the third percentile. The prevalence of growth failure varied between countries from 7 to 44% Whereas patients on conservative treatment showed stable growth, height SDS gradually declined on those on dialysis. Parental height, pubertal status and treatment with recombinant growth hormone (GH) were positively, and the diagnosis of syndromic disease and CKD stage were negatively associated with height SDS during the observation period. Unexpectedly, higher body mass index (BMI) SDS was associated with lower height SDS both at enrolment and during follow up. Renal anemia, metabolic acidosis, and hyperparathyroidism were mostly mild and not predictive of growth rates by multivariable analysis. GH therapy was applied in only 15% of growth retarded patients with large variation between countries. When adjusting for all significant covariates listed above, the country of residence remained a highly significant predictor of overall growth performance. In conclusion, growth failure remains common in European children with CKD, despite improved general management of CKD complications. The widespread underutilization of GH, an approved efficacious therapy for CKD-associated growth failure, deserves further exploration. |
| first_indexed | 2024-12-11T16:58:38Z |
| format | Article |
| id | doaj.art-147de9b7d25d4ea9875f2881d2a6be13 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-11T16:58:38Z |
| publishDate | 2019-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-147de9b7d25d4ea9875f2881d2a6be132022-12-22T00:57:54ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602019-07-01710.3389/fped.2019.00278466635Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) StudyRouven Behnisch0Marietta Kirchner1Ali Anarat2Justine Bacchetta3Rukshana Shroff4Yelda Bilginer5Sevgi Mir6Salim Caliskan7Dusan Paripovic8Jerome Harambat9Francesca Mencarelli10Rainer Büscher11Klaus Arbeiter12Oguz Soylemezoglu13Ariane Zaloszyc14Aleksandra Zurowska15Anette Melk16Uwe Querfeld17Franz Schaefer18and the 4C Study ConsortiumInstitute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyInstitute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyDepartment of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, TurkeyHôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, FranceDivision of Pediatric Nephrology, Great Ormond Street Hospital, London, United KingdomDepartment of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, TurkeyDepartment of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, TurkeyDivision of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, TurkeyDepartment of Pediatric Nephrology, University Children's Hospital, Belgrade, SerbiaPediatric Nephrology Unit, Bordeaux University Hospital, INSERM Unité Mixte de Recherche, Bordeaux, France0Pediatric Nephrology Unit, Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy1Pediatric Nephrology, University Children‘s Hospital, University of Duisburg-Essen, Essen, Germany2Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria3Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey4CHU Hautepierre, Strasbourg, France5Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland6Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany7Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany8Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, GermanyFailure of statural growth is one of the major long-term sequelae of chronic kidney disease (CKD) in children. In recent years effective therapeutic strategies have become available that lead to evidence based practice recommendations. To assess the current growth performance of European children and adolescents with CKD, we analyzed a cohort of 594 patients from 12 European countries who were followed prospectively for up to 6 years in the 4C Study. While all patients were on conservative treatment with a mean estimated glomerular filtration rate of 28 ml/min/1.73 m2 at study entry, 130 children commenced dialysis during the observation period. At time of enrolment the mean height standard deviation score (SDS) was −1.57; 36% of patients had a height below the third percentile. The prevalence of growth failure varied between countries from 7 to 44% Whereas patients on conservative treatment showed stable growth, height SDS gradually declined on those on dialysis. Parental height, pubertal status and treatment with recombinant growth hormone (GH) were positively, and the diagnosis of syndromic disease and CKD stage were negatively associated with height SDS during the observation period. Unexpectedly, higher body mass index (BMI) SDS was associated with lower height SDS both at enrolment and during follow up. Renal anemia, metabolic acidosis, and hyperparathyroidism were mostly mild and not predictive of growth rates by multivariable analysis. GH therapy was applied in only 15% of growth retarded patients with large variation between countries. When adjusting for all significant covariates listed above, the country of residence remained a highly significant predictor of overall growth performance. In conclusion, growth failure remains common in European children with CKD, despite improved general management of CKD complications. The widespread underutilization of GH, an approved efficacious therapy for CKD-associated growth failure, deserves further exploration.https://www.frontiersin.org/article/10.3389/fped.2019.00278/fullchildrenchronic kidney diseaseheightstatural growthGFR—glomerular filtration rateanemia |
| spellingShingle | Rouven Behnisch Marietta Kirchner Ali Anarat Justine Bacchetta Rukshana Shroff Yelda Bilginer Sevgi Mir Salim Caliskan Dusan Paripovic Jerome Harambat Francesca Mencarelli Rainer Büscher Klaus Arbeiter Oguz Soylemezoglu Ariane Zaloszyc Aleksandra Zurowska Anette Melk Uwe Querfeld Franz Schaefer and the 4C Study Consortium Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study Frontiers in Pediatrics children chronic kidney disease height statural growth GFR—glomerular filtration rate anemia |
| title | Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study |
| title_full | Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study |
| title_fullStr | Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study |
| title_full_unstemmed | Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study |
| title_short | Determinants of Statural Growth in European Children With Chronic Kidney Disease: Findings From the Cardiovascular Comorbidity in Children With Chronic Kidney Disease (4C) Study |
| title_sort | determinants of statural growth in european children with chronic kidney disease findings from the cardiovascular comorbidity in children with chronic kidney disease 4c study |
| topic | children chronic kidney disease height statural growth GFR—glomerular filtration rate anemia |
| url | https://www.frontiersin.org/article/10.3389/fped.2019.00278/full |
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