Elaine Ku1, Richard N Fine2, Chi-Yuan Hsu3, Charles McCulloch4, David V Glidden4, Barbara Grimes4, Kirsten L Johansen3. 1. Division of Nephrology, Department of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, and elaine.ku@ucsf.edu. 2. Division of Pediatric Nephrology, Department of Pediatrics, Stony Brook University, Stony Brook, New York. 3. Division of Nephrology, Department of Medicine. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Fransicso, California; and.
Abstract
BACKGROUND AND OBJECTIVES: Poor linear growth is common in children with CKD and has been associated with higher mortality. However, recent data in adult dialysis patients have suggested a higher risk of death in persons of tall stature. In this study, we aimed to examine the risk of all-cause and cause-specific mortality in children at both extremes of height at the time of first RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we performed a retrospective analysis of 13,218 children aged 2-19 years, who received their first RRT (dialysis or transplant) during 1995-2011. We used adjusted Cox models to examine the association between short (<3rd percentile) and tall (>3rd percentile) stature and risk of death, compared with less extreme heights. RESULTS: Over a median follow-up of 7.1 years, there were 1721 deaths. Risk of death was higher in children with short (hazard ratio, 1.49; 95% confidence interval, 1.33 to 1.66) and tall stature (hazard ratio, 1.32; 95% confidence interval, 1.03 to 1.69) in adjusted analysis. In secondary analyses, there was a statistically significant interaction between height and body mass index categories (P=0.04), such that the association of tall stature with higher mortality was limited to children with elevated body mass index (defined as ≥95th percentile for age and sex). Children with short stature had a higher risk of cardiac- and infection-related death, whereas children with tall stature had a higher risk of cancer-related death. CONCLUSIONS: Children with short and tall stature are at higher mortality risk, although this association was modified by body mass index at time of first RRT. Studies to further explore the reasons behind the higher risk of mortality in children with extremes of height at the time of first RRT are warranted.
BACKGROUND AND OBJECTIVES: Poor linear growth is common in children with CKD and has been associated with higher mortality. However, recent data in adult dialysis patients have suggested a higher risk of death in persons of tall stature. In this study, we aimed to examine the risk of all-cause and cause-specific mortality in children at both extremes of height at the time of first RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we performed a retrospective analysis of 13,218 children aged 2-19 years, who received their first RRT (dialysis or transplant) during 1995-2011. We used adjusted Cox models to examine the association between short (<3rd percentile) and tall (>3rd percentile) stature and risk of death, compared with less extreme heights. RESULTS: Over a median follow-up of 7.1 years, there were 1721 deaths. Risk of death was higher in children with short (hazard ratio, 1.49; 95% confidence interval, 1.33 to 1.66) and tall stature (hazard ratio, 1.32; 95% confidence interval, 1.03 to 1.69) in adjusted analysis. In secondary analyses, there was a statistically significant interaction between height and body mass index categories (P=0.04), such that the association of tall stature with higher mortality was limited to children with elevated body mass index (defined as ≥95th percentile for age and sex). Children with short stature had a higher risk of cardiac- and infection-related death, whereas children with tall stature had a higher risk of cancer-related death. CONCLUSIONS:Children with short and tall stature are at higher mortality risk, although this association was modified by body mass index at time of first RRT. Studies to further explore the reasons behind the higher risk of mortality in children with extremes of height at the time of first RRT are warranted.
Authors: Jérôme Harambat; Marjolein Bonthuis; Karlijn J van Stralen; Gema Ariceta; Nina Battelino; Anna Bjerre; Timo Jahnukainen; Valérie Leroy; György Reusz; Ana R Sandes; Manish D Sinha; Jaap W Groothoff; Christian Combe; Kitty J Jager; Enrico Verrina; Franz Schaefer Journal: Clin J Am Soc Nephrol Date: 2013-10-31 Impact factor: 8.237
Authors: C S Wong; D S Gipson; D L Gillen; S Emerson; T Koepsell; D J Sherrard; S L Watkins; C Stehman-Breen Journal: Am J Kidney Dis Date: 2000-10 Impact factor: 8.860
Authors: Robert J Kuczmarski; Cynthia L Ogden; Shumei S Guo; Laurence M Grummer-Strawn; Katherine M Flegal; Zuguo Mei; Rong Wei; Lester R Curtin; Alex F Roche; Clifford L Johnson Journal: Vital Health Stat 11 Date: 2002-05
Authors: Tom D Blydt-Hansen; Christopher B Pierce; Yi Cai; Dmitri Samsonov; Susan Massengill; Marva Moxey-Mims; Bradley A Warady; Susan L Furth Journal: Clin J Am Soc Nephrol Date: 2013-11-21 Impact factor: 8.237
Authors: Christopher P Nelson; Stephen E Hamby; Danish Saleheen; Jenna C Hopewell; Lingyao Zeng; Themistocles L Assimes; Stavroula Kanoni; Christina Willenborg; Stephen Burgess; Phillipe Amouyel; Sonia Anand; Stefan Blankenberg; Bernhard O Boehm; Robert J Clarke; Rory Collins; George Dedoussis; Martin Farrall; Paul W Franks; Leif Groop; Alistair S Hall; Anders Hamsten; Christian Hengstenberg; G Kees Hovingh; Erik Ingelsson; Sekar Kathiresan; Frank Kee; Inke R König; Jaspal Kooner; Terho Lehtimäki; Winifred März; Ruth McPherson; Andres Metspalu; Markku S Nieminen; Christopher J O'Donnell; Colin N A Palmer; Annette Peters; Markus Perola; Muredach P Reilly; Samuli Ripatti; Robert Roberts; Veikko Salomaa; Svati H Shah; Stefan Schreiber; Agneta Siegbahn; Unnur Thorsteinsdottir; Giovani Veronesi; Nicholas Wareham; Cristen J Willer; Pierre A Zalloua; Jeanette Erdmann; Panos Deloukas; Hugh Watkins; Heribert Schunkert; John Danesh; John R Thompson; Nilesh J Samani Journal: N Engl J Med Date: 2015-04-08 Impact factor: 91.245
Authors: Elaine Ku; Joel D Kopple; Charles E McCulloch; Bradley A Warady; Susan L Furth; Robert H Mak; Barbara A Grimes; Mark Mitsnefes Journal: Am J Kidney Dis Date: 2017-11-11 Impact factor: 8.860
Authors: Oleh Akchurin; Angara Sureshbabu; Steve B Doty; Yuan-Shan Zhu; Edwin Patino; Susanna Cunningham-Rundles; Mary E Choi; Adele Boskey; Stefano Rivella Journal: Am J Physiol Renal Physiol Date: 2016-07-20