Adverse clinical outcomes associated with short stature at dialysis initiation: A report of the North American Pediatric Renal Transplant Cooperative Study

Objective. We examined whether height less than the 1% for age (z score <-2.5) at dialysis initiation predicts adverse clinical outcomes for children with kidney failure. Design. National cohort study of children initiating dialysis, followed for a minimum of 1 month to a maximum of 8 years. Setting. Voluntary consortium of pediatric nephrology centers across the United States and Canada in the North American Pediatric Renal Transplant Cooperative Study. Patients. Two thousand three hundred six patients ≤21 years old initiated on dialysis between 1992 and 2000. Outcome Measures. School attendance, transplant wait listing, hospitalization rates, and survival. Results. Although there were no differences in transplant wait listings, school-aged children with short stature were less likely to be attending school full-time than were their counterparts with more normal height, even if medically capable. Short-stature patients have significantly more hospital days per month of dialysis follow-up than those patients with better growth (mean: 1.92 vs 1.58; median: 0.73 vs 0.44 hospital days per month of follow-up). Cox proportional hazards regression analyses show that children with height <1% for age have a twofold higher risk of death than those with more normal height, even after controlling for patient age, race, gender, cause of end-stage renal disease, wait list status, and dialysis modality. Conclusions. Poor growth during chronic renal insufficiency leading to short stature at dialysis initiation is a marker for a more complicated clinical course for children with kidney failure. Aggressive nutritional support and early referral to a nephrologist to optimize growth may improve long-term outcomes for children with chronic kidney disease.