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Pediatric Nephrology
Published in: Pediatric Nephrology 5/2019

01-05-2019 | Kidney Transplantation | Original Article

Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant

Authors: Yijun Li, Larry A. Greenbaum, Bradley A. Warady, Susan L. Furth, Derek K. Ng

Published in: Pediatric Nephrology | Issue 5/2019

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Abstract

Background

Among children who receive a kidney transplant, short stature is associated with a more complicated post-transplant course and increased mortality. Short stature prior to transplant may reflect the accumulated risk of multiple factors during chronic kidney disease (CKD); however, its relationship with post-transplant kidney function has not been well characterized.

Methods

In the Chronic Kidney Disease in Children (CKiD) cohort restricted to children who received a kidney transplant, short stature (i.e., growth failure) was defined as age-sex-specific height < 3rd percentile. The outcome was time to estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2 after transplant. Parametric survival models, including adjustment for disease severity, socioeconomic status (SES), and parental height by inverse probability weighting, described the relative times to eGFR< 45 ml/min/1.73 m2.

Results

Of 138 children (median CKD duration at transplant: 13 years), 20% (28) had short stature before the transplant. The median time to eGFR < 45 ml/min/1.73 m2 after kidney transplantation was 6.6 years and those with short stature had a significantly faster time to the poor outcome (log-rank p value 0.004). Children with short stature tended to have lower SES, nephrotic proteinuria, higher blood pressure, and lower mid-parental height before transplant. After adjusting for these variables, children with growth failure had 40% shorter time to eGFR < 45 ml/min/1.73 m2 than those with normal stature (relative time 0.60, 95%CI 0.32, 1.03).

Conclusions

Short stature was associated with a faster time to low kidney function after transplant. SES, disease severity, and parental height partially explained the association. Clinicians should be aware of the implications of growth failure on the outcome of this unique population, while continued attempts are made to define modifiable factors that contribute to this association.
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Metadata
Title
Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant
Authors
Yijun Li
Larry A. Greenbaum
Bradley A. Warady
Susan L. Furth
Derek K. Ng
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 5/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-018-4165-2

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