Adverse clinical outcomes associated with short stature at dialysis initiation: a report of the North American Pediatric Renal Transplant Cooperative Study.
OBJECTIVE: We examined whether height less than the 1% for age (z score <-2.5) at dialysis initiation predicts adverse clinical outcomes for children with kidney failure.
DESIGN: National cohort study of children initiating dialysis, followed for a minimum of 1 month to a maximum of 8 years.
SETTING: Voluntary consortium of pediatric nephrology centers across the United States and Canada in the North American Pediatric Renal Transplant Cooperative Study.
PATIENTS: Two thousand three hundred six patients =21 years old initiated on dialysis between 1992 and 2000. Outcome Measures. School attendance, transplant wait listing, hospitalization rates, and survival.
RESULTS: Although there were no differences in transplant wait listings, school-aged children with short stature were less likely to be attending school full-time than were their counterparts with more normal height, even if medically capable. Short-stature patients have significantly more hospital days per month of dialysis follow-up than those patients with better growth (mean: 1.92 vs 1.58; median: 0.73 vs 0.44 hospital days per month of follow-up). Cox proportional hazards regression analyses show that children with height <1% for age have a twofold higher risk of death than those with more normal height, even after controlling for patient age, race, gender, cause of end-stage renal disease, wait list status, and dialysis modality.
CONCLUSIONS: Poor growth during chronic renal insufficiency leading to short stature at dialysis initiation is a marker for a more complicated clinical course for children with kidney failure. Aggressive nutritional support and early referral to a nephrologist to optimize growth may improve long-term outcomes for children with chronic kidney disease.