Julien Hogan1,2, Michael F Schneider3, Rima Pai4, Michelle R Denburg5, Amy Kogon5, Ellen R Brooks6, Frederick J Kaskel7, Kimberly J Reidy7, Jeffrey M Saland8, Bradley A Warady9, Susan L Furth5, Rachel E Patzer4, Larry A Greenbaum10. 1. Emory Transplant Center, Department of Surgery, Emory School of Medicine, 5001 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA, 30322, USA. Julien.hogan@emory.edu. 2. Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France. Julien.hogan@emory.edu. 3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Emory Transplant Center, Department of Surgery, Emory School of Medicine, 5001 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA, 30322, USA. 5. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA. 6. Department of Pediatric Kidney Diseases, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 7. Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York, USA. 8. Department of Pediatrics, Kravis Children's Hospital at the Icahn School of Medicine, New York, NY, USA. 9. Department of Pediatrics, University of Missouri-Kansas City School of Medicine and Children's Mercy Kansas City, Kansas City, MO, USA. 10. Department of Pediatrics, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
Abstract
BACKGROUND: The relationship between muscle strength and chronic kidney disease (CKD) in children is unknown. This study aims to quantify the association between grip strength (GS) and kidney function and to explore factors associated with grip strength in children and adolescents with CKD. METHODS: We included 411 children (699 GS assessments) of the Chronic Kidney Disease in Children (CKiD) study. They were matched by age, sex, and height to a healthy control from the National Health and Nutrition Examination Survey to quantify the relationship between GS and CKD. Linear mixed models were used to identify factors associated with GS among CKD patients. RESULTS: Median GS z-score was - 0.72 (IQR - 1.39, 0.11) among CKD patients with CKD stages 2 through 5 having significantly lower GS than CKD stage 1. Compared with healthy controls, CKiD participants had a decreased GS z-score (- 0.53 SD lower, 95% CI - 0.67 to - 0.39) independent of race/ethnicity and body mass index. Factors associated with reduced GS included longer duration of CKD, pre-pubertal status, delayed puberty, neuropsychiatric comorbidities, need of feeding support, need for alkali therapy, and hemoglobin level. Decreased GS was also associated with both a lower frequency and intensity of physical activity. CONCLUSIONS: CKD is associated with impaired muscle strength in children independent of growth retardation and BMI. Exposure to CKD for a prolonged time is associated with impaired muscle strength. Potential mediators of the impact of CKD on muscle strength include growth retardation, acidosis, poor nutritional status, and low physical activity. Additional studies are needed to assess the efficacy of interventions targeted at these risk factors.
BACKGROUND: The relationship between muscle strength and chronic kidney disease (CKD) in children is unknown. This study aims to quantify the association between grip strength (GS) and kidney function and to explore factors associated with grip strength in children and adolescents with CKD. METHODS: We included 411 children (699 GS assessments) of the Chronic Kidney Disease in Children (CKiD) study. They were matched by age, sex, and height to a healthy control from the National Health and Nutrition Examination Survey to quantify the relationship between GS and CKD. Linear mixed models were used to identify factors associated with GS among CKDpatients. RESULTS: Median GS z-score was - 0.72 (IQR - 1.39, 0.11) among CKDpatients with CKD stages 2 through 5 having significantly lower GS than CKD stage 1. Compared with healthy controls, CKiD participants had a decreased GS z-score (- 0.53 SD lower, 95% CI - 0.67 to - 0.39) independent of race/ethnicity and body mass index. Factors associated with reduced GS included longer duration of CKD, pre-pubertal status, delayed puberty, neuropsychiatric comorbidities, need of feeding support, need for alkali therapy, and hemoglobin level. Decreased GS was also associated with both a lower frequency and intensity of physical activity. CONCLUSIONS:CKD is associated with impaired muscle strength in children independent of growth retardation and BMI. Exposure to CKD for a prolonged time is associated with impaired muscle strength. Potential mediators of the impact of CKD on muscle strength include growth retardation, acidosis, poor nutritional status, and low physical activity. Additional studies are needed to assess the efficacy of interventions targeted at these risk factors.
Entities:
Keywords:
Children; Chronic kidney disease; Muscle strength; Outcomes; Quality of life
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