The Impact of Short Stature on Health-Related Quality of Life in Children with Chronic Kidney Disease

doi:10.1016/j.jpeds.2013.03.016

The Journal of Pediatrics

Volume 163, Issue 3, September 2013, Pages 736-741.e1

Portions of the study were presented as a poster at the American Society of Nephrology's meeting, November 19, 2010, Denver, CO.

https://doi.org/10.1016/j.jpeds.2013.03.016 Get rights and content

Objectives

To compare the health-related quality of life (HRQoL) of children with chronic kidney disease (CKD) and short stature (SS) with that of children with CKD and normal height (NH), to evaluate the impact of catch-up growth and growth hormone (GH) use on HRQoL, and to describe the concordance of perceptions of HRQoL between children with SS and NH and their parents.

Study design

Four hundred eighty-three children and/or parents enrolled in the multicenter Chronic Kidney Disease in Children study who had completed the Pediatric Quality of Life Inventory (Version 4.0) on at least 2 Chronic Kidney Disease in Children study visits composed this substudy population. Participants were dichotomized into NH or SS groups. The demographic characteristics that varied at baseline (sex, glomerular filtration rate, and parent education) were controlled for in the main analysis evaluating the impact of catch-up growth and use of GH on HRQoL.

Results

Multivariate modeling (controlling for confounding variables) revealed a significant association between both catch-up growth and GH use on parent–proxy reports of child physical functioning (P < .05) and social functioning (P < .05). Older children with CKD (15-17 years old) had significantly higher ratings than their parents on the Pediatric Quality of Life Inventory Physical, Emotional, Social, and School Functioning scales compared with younger children (8-14 years old).

Conclusion

The finding that height gains and GH use are associated with increases in physical and social functioning by parent report provides additional support for interventions to improve height in children with CKD. The importance of evaluating both the parent and child perceptions of HRQoL is supported by our results.

Section snippets

Methods

This study uses data collected in the multicenter Chronic Kidney Disease in Children (CKiD) study. The CKiD study design and objectives have been previously described.¹⁷ In brief, CKiD is a prospective, longitudinal, observational study of children with CKD who are enrolled at ages 1-16 years. The study protocol includes periodic assessments of HRQoL of children aged ≥8 years and their parents. This study is composed of 483 children who were recruited into CKiD and who had at least 2

Results

The age range of children in this study was 2-17 years at baseline and 3-18 years at the time of analysis. Of the 483 subjects, 297 (61.5%) were boys, and 71 (15%) had SS at baseline. Among children with SS, only 17 (24%) were receiving GH. Among children with NH, 41 (10%) were receiving GH therapy.

The 2 groups were comparable at baseline in all characteristics except sex, iGFR, and ME. Compared with the SS group, a higher percentage of boys, a higher iGFR, and higher ME were observed in the NH

Discussion

The use of GH is not a universally accepted clinical practice in children with CKD²³ despite the positive effect of GH therapy on height.²⁴ It has been speculated that the absence of research demonstrating a definitive difference in the HRQoL of children with SS and NH, as well as the absence of research demonstrating that improvements in height are associated with improvements in HRQoL, has hindered the widespread use of GH treatment of children with SS.5, 12, 23 The present study sought to

References (29)

W.C. Arnold et al.
Effects of caloric supplementation of growth in children with uremia
Kidney Int
(1983)
P.M. Jehle et al.
Insulin-like growth factor system components in hyperparathyroidism and renal osteodystrophy
Kidney Int
(2000)
B. Stabler et al.
Behavior change after growth hormone treatment of children with short stature
J Pediatr
(1998)
IC Huang et al.
Agreement was not found in adolescents’ quality of life rated by parents and adolescents
J Clin Epidemiol
(2009)
G.J. Schwartz et al.
Glomerular filtration rate via plasma iohexol disappearance: pilot study for chronic kidney disease in children
Kidney Int
(2006)
L. Steinberg
Cognitive and affective development in adolescence
Trends Cogn Sci
(2005)
A Grimberg et al.
Sex differences in patients referred for evaluation of poor growth
J Pediatr
(2005)
J.D. Hanna et al.
Effects of uremia on growth in children
Semin Nephrol
(1996)
B. Tonshoff et al.
Derangements of the somatotropic hormone axis in chronic renal failure
Kidney Int
(1997)
M.G. Seikaly et al.
Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS
Pediatri Nephrol
(2007)

T.A. Judge et al.

The effect of physical height on workplace success and income: preliminary test of a theoretical model

J Appl Psychol

(2004)

J.D. Sargent et al.

Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort

Arch Pediatr Adolesc Med

(1994)

W.E. Hensley

Height as a basis for interpersonal attraction

Adolescence

(1994)

Brackbill Y, Nevill DD. Parental expectations of achievement as affected by children's height. Merrill-Palmer Q...

Cited by (100)

Estimating Total Energy Expenditure to Determine Energy Requirements in Free-Living Children With Stage 3 Chronic Kidney Disease: Can a Structured Approach Help Improve Clinical Care?
2024, Journal of Renal Nutrition
Malnutrition and obesity are complex burdensome challenges in pediatric chronic kidney disease (CKD) management that can adversely affect growth, disease progression, wellbeing, and response to treatment. Total energy expenditure (TEE) and energy requirements in children are essential for growth outcomes but are poorly defined, leaving clinical practice varied and insecure. The aims of this study were to explore a practical approach to guide prescribed nutritional interventions, using measurements of TEE, physical activity energy expenditure (PAEE), and their relationship to kidney function.
In a cross-sectional prospective age-matched and sex-matched controlled study, 18 children with CKD (6-17 years, mean stage 3) and 20 healthy, age-matched, and gender-matched controls were studied. TEE and PAEE were measured using basal metabolic rate (BMR), activity diaries and doubly labeled water (healthy subjects). Results were related to estimated glomerular filtration rate (eGFR). The main outcome measure was TEE measured by different methods (factorial, doubly labeled water, and a novel device).
Total energy expenditure and PAEE with or without adjustments for age, gender, weight, and height did not differ between the groups and was not related to eGFR. TEE ranged from 1927 ± 91 to 2330 ± 73 kcal/d; 95 ± 5 to 109 ± 5% estimated average requirement (EAR), physical activity level (PAL) 1.52 ± 0.01 to 1.71 ± 0.17, and PAEE 24 to 34% EAR. Comparisons between DLW and alternative methods in healthy children did not differ significantly, except for 2 (factorial methods and a fixed PAL; and the novel device).
In clinical practice, structured approaches using supportive evidence (weight, height, BMI sds), predictive BMR or TEE values and simple questions on activity, are sufficient for most children with CKD as a starting energy prescription.
Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics
2023, Seminars in Nephrology
Kidney transplantation is the treatment of choice for all patients with end-stage kidney disease, including pediatric patients. Graft survival in pediatrics was lagging behind adults, but now is comparable with the adult cohort. Although many of the protocols have been adopted from adults, there are issues unique to pediatrics that one should be aware of to take care of this population. These issues include recipient size consideration, increased incidence of viral infections, problems related to growth, common occurrence of underlying urological issues, and psychosocial issues. This article addresses the similarities and differences in renal transplantation, from preparing a patient for transplant, the transplant process, to post-transplant complications.
Pediatric Chronic Kidney Disease
2022, Advances in Pediatrics
The Relationship Between Neighborhood Disadvantage and Kidney Disease Progression in the Chronic Kidney Disease in Children (CKiD) Cohort
2022, American Journal of Kidney Diseases
To examine the relationship between neighborhood poverty and deprivation, chronic kidney disease (CKD) comorbidities, and disease progression in children with CKD.
Observational cohort study.
Children with mild to moderate CKD enrolled in the CKiD (Chronic Kidney Disease in Children) study with available US Census data.
Neighborhood poverty and neighborhood disadvantage.
Binary outcomes of short stature, obesity, hypertension, and health care utilization for cross-sectional analysis; a CKD progression end point (incident kidney replacement therapy [KRT] or 50% loss in estimated glomerular filtration rate), and mode of first KRT for time-to-event analysis.
Cross-sectional analysis of health characteristics at time of first Census data collection using logistic regression to estimate odds ratios. Risk for CKD progression was analyzed using a Cox proportional hazard model. Multivariable models were adjusted for race, ethnicity, sex, and family income.
There was strong agreement between family and neighborhood socioeconomic characteristics. Risk for short stature, hospitalization, and emergency department (ED) use were significantly associated with lower neighborhood income. After controlling for race, ethnicity, sex, and family income, the odds of hospitalization (OR, 1.71 [95% CI, 1.08-2.71]) and ED use (OR, 1.56 [95% CI, 1.02-2.40]) remained higher for those with lower neighborhood income. The hazard ratio of reaching the CKD progression outcome for participants living in lower income neighborhoods was significantly increased in the unadjusted model only (1.38 [95% CI, 1.02-1.87]). Likelihood of undergoing a preemptive transplant was decreased with lower neighborhood income (OR, 0.47 [95% CI, 0.24-0.96]) and higher neighborhood deprivation (OR, 0.31 [95% CI, 0.10-0.97]), but these associations did not persist after controlling for participant characteristics.
Limited generalizability, as only those with consistent longitudinal nephrology care were studied.
Neighborhood-level socioeconomic status (SES) was associated with poorer health characteristics and CKD progression in univariable analysis. However, the relationships were attenuated after accounting for participant-level factors including race. A persistent association of neighborhood poverty with hospitalizations and ED suggests an independent effect of SES on health care utilization, the causes for which deserve additional study.
Growth in Children With End-Stage Kidney Disease
2022, Handbook of Dialysis Therapy
Growth is a complex process dependent on adequate nutrition and interconnected metabolic and endocrine pathways; growth failure is one of the most common and important complications seen in children with chronic kidney disease (CKD). Advances in understanding the crucial role of nutrition and the growth hormone-insulin-like growth factor-1 (GH/IGF-1) axis has continued to expand. Moreover, CKD clinical manifestations can be highly variable, including fluid/electrolyte abnormalities, metabolic acidosis, abnormal bone metabolism, and malnutrition, all of which can significantly affect growth. Different medical interventions and renal replacement therapy can also impact growth and development.
Children receiving kidney transplants and/or treatment with recombinant human GH (rhGH) show better mean final height than those who continue on long-term dialysis and/or did not receive concomitant rhGH therapy. Young age at end-stage kidney disease (ESKD) onset, severity and duration of renal failure, male gender, and presence of congenital nephropathies are the most relevant risk factors for decreased final adult height.
The multifactorial pathogenesis of growth failure in children with CKD complicates the approach to prevention and treatment. The impact of growth failure in children with CKD can be profound, including significant neurodevelopmental and behavioral issues and increased hospitalizations and mortality.
Promotion of growth requires (1) attention to pathogenic factors and (2), in many children, treatment with rhGH. Best results with rhGH are seen with earlier treatment and adjustment of dose as the child grows. This chapter presents a detailed algorithm that can provide a step-by-step approach to the management of these children with CKD.
Epidemiology of pediatric chronic kidney disease
2021, Nephrologie et Therapeutique
Des progrès majeurs ont été réalisés dans la prise en charge des enfants avec une maladie rénale chronique au cours des 30 dernières années. Cependant, les données épidémiologiques pédiatriques existantes proviennent essentiellement des registres de traitement de suppléance de l’insuffisance rénale terminale, et les informations disponibles aux stades plus précoces de maladie rénale chronique sont limitées. L’incidence et la prévalence de la maladie rénale chronique de stades 2 à 5 restent mal connues. De rares études en population suggèrent toutefois que la prévalence de la maladie rénale chronique tous stades confondus pourrait concerner 1 % de la population pédiatrique. Les désordres congénitaux incluant les hypodysplasies rénales et uropathies malformatives (Congenital abnormalities of the kidney and urinary tract) et les néphropahies héréditaires sont responsables de la moitié à deux tiers des cas de maladie rénale chronique de l’enfant dans les pays industrialisés, alors que les néphropathies acquises prédominent dans les pays en développement. La progression de la maladie rénale chronique est plus lente chez les enfants avec un désordre congénital que chez ceux ayant une néphropathie acquise en particulier glomérulaire, résultant en une plus faible proportion de Congenital abnormalities of the kidney and urinary tract comme cause d’insuffisance rénale terminale par rapport aux stades moins avancés de maladie rénale chronique. L’incidence du traitement de suppléance rénale dans la population pédiatrique variait selon les pays de 1 à 14 par million d’enfants du même âge en 2018 (environ 8 par million d’enfants en France) chez les patients de moins de 20 ans. La prévalence du traitement de suppléance rénale chez les moins de 20 ans en 2018 variait de 15 à 30 par million d’enfants dans certains pays d’Europe de l’Est et d’Amérique latine à 100 par million d’enfants en Finlande et aux États-Unis (56 par million d’enfants en France). La plupart des enfants atteints d’insuffisance rénale terminale démarrent un traitement de suppléance par dialyse (plus fréquemment hémodialyse que dialyse péritonéale). Dans environ 20 % des cas, le traitement initial est une greffe rénale préemptive. Dans les pays industrialisés, 60 à 80 % des patients prévalents vivent avec un greffon fonctionnel (75 % en France). Alors que la survie des enfants atteints de maladie rénale chronique s’est continuellement améliorée au cours du temps, la mortalité reste de l’ordre de 30 fois supérieure à celle de la population générale pédiatrique.
Major advances have been made in the management of children with chronic kidney disease over the past 30 years. However, existing epidemiology data are primarily from kidney replacement therapy registries, and information available at earlier stages of chronic kidney disease is limited. The incidence and prevalence of chronic kidney disease stages 2 to 5 remain poorly understood. However, rare population-based studies suggest that the prevalence of all-stage chronic kidney disease may be as high as 1% of the pediatric population. Congenital disorders including congenital abnormalities of the kidney and urinary tract and hereditary nephropathies account for one-half to two-thirds of pediatric chronic kidney disease cases in middle and high-income countries, whereas acquired nephropathies seem to predominate in low-income countries. The progression of chronic kidney disease is slower in children with congenital disorders than in those with acquired nephropathy, particularly glomerular disease, resulting in a lower proportion of congenital abnormalities of the kidney and urinary tract as a cause of end-stage kidney disease compared to less advanced stages of chronic kidney disease. The incidence of kidney replacement therapy in the pediatric population ranged by country from 1 to 14 per million children of the same age in 2018 (approximately 8 per million children in France) in patients younger than 20 years. The prevalence of kidney replacement therapy in children under 20 years of age in 2018 ranged from 15-30 per million children in some Eastern European and Latin American countries to 100 per million children in Finland and the United States (56 per million children in France). Most children with end-stage kidney disease initiate kidney replacement therapy with dialysis (more frequently hemodialysis than peritoneal dialysis). In about 20% of cases, the initial kidney replacement therapy modality is a pre-emptive kidney transplantation. In high-income countries, 60-80% of prevalent children with end-stage kidney disease live with a functioning transplant (75% in France). While the survival of children with chronic kidney disease has continuously improved over time, mortality remains about 30 times higher than in the general pediatric population.

View all citing articles on Scopus

: Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (UO1-DK-66143, UO1-DK-66174, U01-DK-82194, and UO1-DK-66116). The authors are solely responsible for the data analysis, and interpretation of data, in the writing of the report, and the decision to submit the paper for publication. The authors declare no conflicts of interest.

: Registered with ClinicalTrials.gov: NCT00327860.

^∗: A list of members of the CKiD Study Group is available at www.jpeds.com (Appendix).

View full text

Original ArticleThe Impact of Short Stature on Health-Related Quality of Life in Children with Chronic Kidney Disease

Objectives

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

Kidney Int

Kidney Int

J Pediatr

J Clin Epidemiol

Kidney Int

Trends Cogn Sci

J Pediatr

Effects of uremia on growth in children

Semin Nephrol

Derangements of the somatotropic hormone axis in chronic renal failure

Kidney Int

Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS

Pediatri Nephrol

The effect of physical height on workplace success and income: preliminary test of a theoretical model

J Appl Psychol

Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort

Arch Pediatr Adolesc Med

Height as a basis for interpersonal attraction

Adolescence

Original Article
The Impact of Short Stature on Health-Related Quality of Life in Children with Chronic Kidney Disease