The Association between Abnormal Birth History and Growth in Children with CKD

• Authors: Laurence Greenbaum, Emory University; Alvaro Munoz, Johns Hopkins; Michael F. Schneider, Johns Hopkins; Frederick J. Kaskel, Albert Einstein School of Medicine; David J. Askenazi, University of Alabama at Birmingham; Randall Jenkins, Emanuel Children's Hospital; Hilary Hotchkiss, Mount Sinai School of Medicine; Marva Moxey-Mims, National Institutes of Health; Susan L. Furth, Johns Hopkins; Bradley A. Warady, Children's Mercy Hospital
• Journal Title: Clinical Journal of the American Society of Nephrology
• Volume: Volume 6, Number 1
• Publisher: American Society of Nephrology | 2011-01, Pages 14-21
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.2215/CJN.08481109
• Subjects: Biology, Physiology; Health Sciences, General; Health Sciences, Human Development

Abstract

Background and objectives: Poor linear growth is a well described complication of chronic kidney disease (CKD). This study evaluated whether abnormal birth history defined by low birth weight (LBW; <2500 g), prematurity (gestational age <36 weeks), small for gestational age (SGA; birth weight <10th percentile for gestational age), or intensive care unit (ICU) at birth were risk factors for poor growth outcomes in children with CKD. Design, setting, participants, & measurements: Growth outcomes were quantified by age-sex-specific height and weight z-scores during 1393 visits from 426 participants of the Chronic Kidney Disease in Children Study, an observational cohort of children with CKD. Median baseline GFR was 42.9 ml/min per 1.73 m2, 21% had a glomerular diagnosis, and 52% had CKD for ≥90% of their lifetime. Results: A high prevalence of LBW (17%), SGA (14%), prematurity (12%), and ICU after delivery (40%) was observed. Multivariate analyses demonstrated a negative effect of LBW (−0.43 ± 0.14; P < 0.01 for height and −0.37 ± 0.16; P = 0.02 for weight) and of SGA (−0.29 ± 0.16; P = 0.07 for height and −0.41 ± 0.19; P = 0.03 for weight) on current height and weight. In children with glomerular versus nonglomerular diagnoses, the effect of SGA (−1.08 versus −0.18; P = 0.029) on attained weight was more pronounced in children with a glomerular diagnosis. Conclusions: LBW and SGA are novel risk factors for short stature and lower weight percentiles in children with mild to moderate CKD independent of kidney function.