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Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant.
Pediatric Nephrology ( IF 3 ) Pub Date : 2019-01-09 , DOI: 10.1007/s00467-018-4165-2
Yijun Li 1 , Larry A Greenbaum 2 , Bradley A Warady 3 , Susan L Furth 4 , Derek K Ng 1
Affiliation  

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.

中文翻译:

晚期小儿CKD身材矮小与移植后肾功能降低的时间加快有关。

背景技术在接受肾脏移植的儿童中,身材矮小与更复杂的移植后病程和死亡率增加有关。移植前身材矮小可能反映出慢性肾脏病(CKD)期间多种因素累积的风险;然而,其与移植后肾功能的关系尚未被很好地表征。方法在仅限于接受肾脏移植的儿童的儿童慢性肾脏病(CKiD)队列中,身材矮小(即,生长衰竭)定义为年龄性别特异性身高<3%。结果是移植后估计肾小球滤过率(eGFR)<45 ml / min / 1.73 m2的时间。参数生存模型,包括通过逆概率加权对疾病严重性,社会经济地位(SES)和父母身高进行的调整,描述了相对时间eGFR <45 ml / min / 1.73 m2。结果138名儿童(移植后CKD持续时间中位数:13岁)中有20%(28)的移植前身材矮小。肾移植后eGFR <45 ml / min / 1.73 m2的中位时间为6.6年,而身材矮小的人达到不良结局的时间明显更快(log-rank p值0.004)。身材矮小的儿童在移植前往往具有较低的SES,肾病蛋白尿,较高的血压和较低的父母中间高度。在对这些变量进行调整后,生长发育不良的儿童比正常身高的儿童的eGFR <45 ml / min / 1.73 m2的时间短40%(相对时间为0.60、95%CI 0.32、1.03)。结论身材矮小与移植后肾功能低下时间加快有关。SES,疾病严重程度,父母身高部分说明了这种关联。临床医生应意识到生长衰竭对这一独特人群的后果的影响,同时继续尝试确定有助于这种关联的可改变因素。
更新日期:2019-11-01
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