Associations of longitudinal height and weight with clinical outcomes in pediatric kidney replacement therapy: results from the ESPN/ERA Registry

• DOI: 10.1007/s00467-023-05973-3
• Publication Date: 2023-05-08T07:02:41Z
• Authors: Marjolein Bonthuis; Sevcan A. Bakkaloglu; Enrico Vidal; Sergey Baiko; Fiona Braddon; Carmela Errichiello; Telma Francisco; Dieter Haffner; Annie Lahoche; Beata Leszczyńska; Jurate Masalkiene; Jelena Stojanovic; Maria S. Molchanova; George Reusz; Adela Rodriguez B...; Alejandra Rosales; Sanja Tegeltija; Elisa Ylinen; Galia Zlatanova; Jérôme Harambat; Kitty J. Jager
• Keywords: 2. Zero hunger; Dwarfism*; Male; Dwarfism; Growth; Thinness* / complications; Body composition; Obesity / complications; Thinness* / epidemiology; HDE NEF PED; 3. Good health; Body Mass Index; Kidney transplantation; Renal Replacement Therapy; Thinness; [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie; Humans; Original Article; Female; Obesity; Registries; Mortality; Child; Children; Gynaecology and paediatrics

Abstract

Background Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT.

Methods We included patients < 20 years starting KRT in 33 European countries from 1995–2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) < –1.88 and tall stature as height SDS > 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates.

Results We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78–0.86), tall (aHR: 0.65, 95% CI: 0.56–0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71–0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92–2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38–2.23) and obese (aHR: 1.49, 95% CI: 1.11–1.99) patients showed higher all-cause mortality risk than normal weight subjects.

Conclusions Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients.

Graphical abstract