Matthew J Roberts1, Mark M Mitsnefes2, Charles E McCulloch3, Larry A Greenbaum4, Barbara A Grimes3, Elaine Ku5,6. 1. School of Medicine, University of California San Francisco, 533 Parnassus Avenue, U404, Box 0532, San Francisco, CA, 94143-0532, USA. matthew.roberts@ucsf.edu. 2. Department of Pediatrics, Division of Pediatric Nephrology, Cincinnati Children's Hospital, Cincinnati, OH, USA. 3. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. 4. Division of Pediatric Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA. 5. Department of Pediatrics, Division of Pediatric Nephrology, University of California San Francisco, San Francisco, CA, USA. 6. Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: Few studies have examined how changes in BMI [body mass index] over time associate with risk of adverse outcomes in children receiving renal replacement therapy [RRT]. The objective of this study was to examine the association between annualized changes in BMI and the risk of death in children treated with RRT. METHODS: We performed a retrospective cohort study of 1182 pediatric dialysis and transplant patients in the Pediatric Growth and Development Special Study of the United States Renal Data System. Quintiles of annualized change in BMI z-score (with cutoffs of - 0.50, - 0.13, 0.09, 0.57) were used as the primary predictor, with the middle quintile (- 0.13 to 0.09) serving as the reference category. Cox models were used to examine the association between exposure and death, with time of analysis starting from the second BMI measurement. RESULTS: Median follow-up time to death or censoring was 6 years. Median age was 14.6 years, and 61% of children had a functional graft at cohort entry. There was a U-shaped association between BMI change and mortality risk: a large decline in annualized BMI z-score change (> - 0.50) was associated with an increased risk of death (adjusted hazard ratio [aHR] 1.54 (95% CI 1.17-2.03), p = 0.002). A large increase in annualized BMI z-score change (> 0.57) was also associated with an increased risk of death (aHR 1.44 (95% CI 1.07-1.92), p = 0.02). No interaction was noted between annualized BMI change and initial treatment modality (dialysis or transplant, p = 0.15). CONCLUSIONS: Maintenance of a stable BMI in pediatric patients receiving RRT may be associated with improved survival.
BACKGROUND: Few studies have examined how changes in BMI [body mass index] over time associate with risk of adverse outcomes in children receiving renal replacement therapy [RRT]. The objective of this study was to examine the association between annualized changes in BMI and the risk of death in children treated with RRT. METHODS: We performed a retrospective cohort study of 1182 pediatric dialysis and transplant patients in the Pediatric Growth and Development Special Study of the United States Renal Data System. Quintiles of annualized change in BMI z-score (with cutoffs of - 0.50, - 0.13, 0.09, 0.57) were used as the primary predictor, with the middle quintile (- 0.13 to 0.09) serving as the reference category. Cox models were used to examine the association between exposure and death, with time of analysis starting from the second BMI measurement. RESULTS: Median follow-up time to death or censoring was 6 years. Median age was 14.6 years, and 61% of children had a functional graft at cohort entry. There was a U-shaped association between BMI change and mortality risk: a large decline in annualized BMI z-score change (> - 0.50) was associated with an increased risk of death (adjusted hazard ratio [aHR] 1.54 (95% CI 1.17-2.03), p = 0.002). A large increase in annualized BMI z-score change (> 0.57) was also associated with an increased risk of death (aHR 1.44 (95% CI 1.07-1.92), p = 0.02). No interaction was noted between annualized BMI change and initial treatment modality (dialysis or transplant, p = 0.15). CONCLUSIONS: Maintenance of a stable BMI in pediatric patients receiving RRT may be associated with improved survival.
Entities:
Keywords:
Body mass index; ESRD; Malnutrition; Obesity; Pediatrics
Authors: Paul W Franks; Robert L Hanson; William C Knowler; Maurice L Sievers; Peter H Bennett; Helen C Looker Journal: N Engl J Med Date: 2010-02-11 Impact factor: 91.245
Authors: Finnian R Mc Causland; Brian Claggett; Emmanuel A Burdmann; Kai-Uwe Eckardt; Reshma Kewalramani; Andrew S Levey; John J V McMurray; Patrick Parfrey; Giuseppe Remuzzi; Ajay K Singh; Scott D Solomon; Robert D Toto; Marc A Pfeffer Journal: Am J Kidney Dis Date: 2016-09-16 Impact factor: 8.860
Authors: Elaine Ku; David V Glidden; Chi-yuan Hsu; Anthony A Portale; Barbara Grimes; Kirsten L Johansen Journal: J Am Soc Nephrol Date: 2015-06-08 Impact factor: 10.121
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: Lorien S Dalrymple; Ronit Katz; Bryan Kestenbaum; Michael G Shlipak; Mark J Sarnak; Catherine Stehman-Breen; Stephen Seliger; David Siscovick; Anne B Newman; Linda Fried Journal: J Gen Intern Med Date: 2010-09-19 Impact factor: 5.128
Authors: Jin Ho Hwang; Jiwon Ryu; Jung Nam An; Clara Tammy Kim; Hyosang Kim; Jaeseok Yang; Jongwon Ha; Dong Wan Chae; Curie Ahn; In Mok Jung; Yun Kyu Oh; Chun Soo Lim; Duck-Jong Han; Su-Kil Park; Yon Su Kim; Young Hoon Kim; Jung Pyo Lee Journal: BMC Nephrol Date: 2015-07-21 Impact factor: 2.388
Authors: Stella Stabouli; Nonnie Polderman; Christina L Nelms; Fabio Paglialonga; Michiel J S Oosterveld; Larry A Greenbaum; Bradley A Warady; Caroline Anderson; Dieter Haffner; An Desloovere; Leila Qizalbash; José Renken-Terhaerdt; Jetta Tuokkola; Johan Vande Walle; Vanessa Shaw; Mark Mitsnefes; Rukshana Shroff Journal: Pediatr Nephrol Date: 2021-08-10 Impact factor: 3.714