Prevention and management of growth failure in children with chronic kidney disease
- Burkhard Tönshoff, MD, PhD
Burkhard Tönshoff, MD, PhD
- Professor of Pediatrics and Pediatric Nephrology
- University Children's Hospital, Heidelberg, Germany
Growth retardation is a major complication of children with chronic kidney disease (CKD). Poor growth is a marker of disease severity and is associated with significant morbidity and mortality [1,2].
The prevention and management of growth impairment in children with CKD and after renal transplantation will be reviewed here. The impact, risk factors, and underlying pathogenesis of growth impairment in children with CKD are discussed separately. (See "Pathogenesis, evaluation and diagnosis of growth impairment in children with chronic kidney disease".)
●G1 – Normal GFR (≥90 mL/min per 1.73 m2)
●G2 – GFR between 60 and 89 mL/min per 1.73 m2
- Mahan JD, Warady BA, Consensus Committee. Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol 2006; 21:917.
- André JL, Bourquard R, Guillemin F, et al. Final height in children with chronic renal failure who have not received growth hormone. Pediatr Nephrol 2003; 18:685.
- KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3:1.
- Rees L, Azocar M, Borzych D, et al. Growth in very young children undergoing chronic peritoneal dialysis. J Am Soc Nephrol 2011; 22:2303.
- Mekahli D, Shaw V, Ledermann SE, Rees L. Long-term outcome of infants with severe chronic kidney disease. Clin J Am Soc Nephrol 2010; 5:10.
- Seikaly MG, Salhab N, Gipson D, et al. Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 2006; 21:793.
- Neu AM, Bedinger M, Fivush BA, et al. Growth in adolescent hemodialysis patients: data from the Centers for Medicare & Medicaid Services ESRD Clinical Performance Measures Project. Pediatr Nephrol 2005; 20:1156.
- Quinlan C, Bates M, Sheils A, et al. Chronic hemodialysis in children weighing less than 10 kg. Pediatr Nephrol 2013; 28:803.
- Shroff R, Wright E, Ledermann S, et al. Chronic hemodialysis in infants and children under 2 years of age. Pediatr Nephrol 2003; 18:378.
- Chadha V, Blowey DL, Warady BA. Is growth a valid outcome measure of dialysis clearance in children undergoing peritoneal dialysis? Perit Dial Int 2001; 21 Suppl 3:S179.
- North American Pediatric Renal Trials and Collaborative Studies. 2011 Annual dialysis report. https://web.emmes.com/study/ped/annlrept/annualrept2011.pdf.
- Kleinknecht C, Broyer M, Gagnadoux MF, et al. Growth in children treated with long-term dialysis. A study of 76 patients. Adv Nephrol Necker Hosp 1980; 9:133.
- Fischbach M, Terzic J, Menouer S, et al. Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 2010; 25:867.
- Hoppe A, von Puttkamer C, Linke U, et al. A hospital-based intermittent nocturnal hemodialysis program for children and adolescents. J Pediatr 2011; 158:95.
- Stefanidis CJ, Hewitt IK, Balfe JW. Growth in children receiving continuous ambulatory peritoneal dialysis. J Pediatr 1983; 102:681.
- Schaefer F, Klaus G, Mehls O. Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group. J Am Soc Nephrol 1999; 10:1786.
- Fine RN, Salusky IB. CAPD/CCPD in children: four years' experience. Kidney Int Suppl 1986; 19:S7.
- International Pediatric Peritoneal Dialysis Network. About IPPN [online] http://www.pedpd.org/index.php?id=98 (Accessed on May 09, 2011).
- Tejani A, Fine R, Alexander S, et al. Factors predictive of sustained growth in children after renal transplantation. The North American Pediatric Renal Transplant Cooperative Study. J Pediatr 1993; 122:397.
- Broyer M, Guest G, Gagnadoux MF. Growth rate in children receiving alternate-day corticosteroid treatment after kidney transplantation. J Pediatr 1992; 120:721.
- Jabs K, Sullivan EK, Avner ED, Harmon WE. Alternate-day steroid dosing improves growth without adversely affecting graft survival or long-term graft function. A report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 1996; 61:31.
- Qvist E, Marttinen E, Rönnholm K, et al. Growth after renal transplantation in infancy or early childhood. Pediatr Nephrol 2002; 17:438.
- Höcker B, Weber LT, Feneberg R, et al. Prospective, randomized trial on late steroid withdrawal in pediatric renal transplant recipients under cyclosporine microemulsion and mycophenolate mofetil. Transplantation 2009; 87:934.
- Höcker B, Weber LT, Feneberg R, et al. Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomised trial in paediatric renal transplantation. Nephrol Dial Transplant 2010; 25:617.
- Benfield MR, Bartosh S, Ikle D, et al. A randomized double-blind, placebo controlled trial of steroid withdrawal after pediatric renal transplantation. Am J Transplant 2010; 10:81.
- Klare B, Montoya CR, Fischer DC, et al. Normal adult height after steroid-withdrawal within 6 months of pediatric kidney transplantation: a 20 years single center experience. Transpl Int 2012; 25:276.
- Grenda R, Watson A, Trompeter R, et al. A randomized trial to assess the impact of early steroid withdrawal on growth in pediatric renal transplantation: the TWIST study. Am J Transplant 2010; 10:828.
- Webb NJ, Douglas SE, Rajai A, et al. Corticosteroid-free Kidney Transplantation Improves Growth: 2-Year Follow-up of the TWIST Randomized Controlled Trial. Transplantation 2015; 99:1178.
- Delucchi A, Valenzuela M, Lillo AM, et al. Early steroid withdrawal in pediatric renal transplant: five years of follow-up. Pediatr Nephrol 2011; 26:2235.
- Grenda R, Webb NJ. Steroid minimization in pediatric renal transplantation: Early withdrawal or avoidance? Pediatr Transplant 2010; 14:961.
- Sarwal MM, Vidhun JR, Alexander SR, et al. Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation. Transplantation 2003; 76:1331.
- Silverstein DM, Aviles DH, LeBlanc PM, et al. Results of one-year follow-up of steroid-free immunosuppression in pediatric renal transplant patients. Pediatr Transplant 2005; 9:589.
- Bhakta N, Marik J, Malekzadeh M, et al. Can pediatric steroid-free renal transplantation improve growth and metabolic complications? Pediatr Transplant 2008; 12:854.
- Sarwal MM, Ettenger RB, Dharnidharka V, et al. Complete steroid avoidance is effective and safe in children with renal transplants: a multicenter randomized trial with three-year follow-up. Am J Transplant 2012; 12:2719.
- Chronic kidney disease
- Growth measurement
- SUPPORTIVE MEASURES
- Other supportive measures
- RENAL REPLACEMENT THERAPY
- Continuous peritoneal dialysis
- Corticosteroid therapy
- - Alternate-day corticosteroid
- - Corticosteroid withdrawal or avoidance
- RECOMBINANT HUMAN GROWTH HORMONE THERAPY
- SUMMARY AND RECOMMENDATIONS