Denver D Brown1, Megan Carroll2, Derek K Ng2, Rebecca V Levy3, Larry A Greenbaum4, Frederick J Kaskel5, Susan L Furth6, Bradley A Warady7, Michal L Melamed8, Andrew Dauber9. 1. Division of Nephrology, Children's National Hospital, Washington, DC. 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, New York. 4. Division of Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia. 5. Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, New York. 6. Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri. 8. Department of Medicine, Albert Einstein College of Medicine, Bronx, New York. 9. Division of Endocrinology, Children's National Hospital, Washington, DC.
Abstract
Background: Poor linear growth is a consequence of chronic kidney disease (CKD) that has been linked to adverse outcomes. Metabolic acidosis (MA) has been identified as a risk factor for growth failure. We investigated the longitudinal relationship between MA and linear growth in children with CKD and examined whether treatment of MA modified linear growth. Methods: To describe longitudinal associations between MA and linear growth, we used serum bicarbonate levels, height measurements, and standard deviation (z scores) of children enrolled in the prospective cohort study Chronic Kidney Disease in Children. Analyses were adjusted for covariates recognized as correlating with poor growth, including demographic characteristics, glomerular filtration rate (GFR), proteinuria, calcium, phosphate, parathyroid hormone, and CKD duration. CKD diagnoses were analyzed by disease categories, nonglomerular or glomerular. Results: The study population included 1082 children with CKD: 808 with nonglomerular etiologies and 274 with glomerular etiologies. Baseline serum bicarbonate levels ≤22 mEq/L were associated with worse height z scores in all children. Longitudinally, serum bicarbonate levels ≤18 and 19-22 mEq/L were associated with worse height z scores in children with nonglomerular CKD causes, with adjusted mean values of -0.39 (95% CI, -0.58 to -0.2) and -0.17 (95% CI, -0.28 to -0.05), respectively. Children with nonglomerular disease and more severe GFR impairment had a higher risk for worse height z score. A significant association was not found in children with glomerular diseases. We also investigated the potential effect of treatment of MA on height in children with a history of alkali therapy use, finding that only persistent users had a significant positive association between their height z score and higher serum bicarbonate levels. Conclusions: We observed a longitudinal association between MA and lower height z score. Additionally, persistent alkali therapy use was associated with better height z scores. Future clinical trials of alkali therapy need to evaluate this relationship prospectively.
Background: Poor linear growth is a consequence of chronic kidney disease (CKD) that has been linked to adverse outcomes. Metabolic acidosis (MA) has been identified as a risk factor for growth failure. We investigated the longitudinal relationship between MA and linear growth in children with CKD and examined whether treatment of MA modified linear growth. Methods: To describe longitudinal associations between MA and linear growth, we used serum bicarbonate levels, height measurements, and standard deviation (z scores) of children enrolled in the prospective cohort study Chronic Kidney Disease in Children. Analyses were adjusted for covariates recognized as correlating with poor growth, including demographic characteristics, glomerular filtration rate (GFR), proteinuria, calcium, phosphate, parathyroid hormone, and CKD duration. CKD diagnoses were analyzed by disease categories, nonglomerular or glomerular. Results: The study population included 1082 children with CKD: 808 with nonglomerular etiologies and 274 with glomerular etiologies. Baseline serum bicarbonate levels ≤22 mEq/L were associated with worse height z scores in all children. Longitudinally, serum bicarbonate levels ≤18 and 19-22 mEq/L were associated with worse height z scores in children with nonglomerular CKD causes, with adjusted mean values of -0.39 (95% CI, -0.58 to -0.2) and -0.17 (95% CI, -0.28 to -0.05), respectively. Children with nonglomerular disease and more severe GFR impairment had a higher risk for worse height z score. A significant association was not found in children with glomerular diseases. We also investigated the potential effect of treatment of MA on height in children with a history of alkali therapy use, finding that only persistent users had a significant positive association between their height z score and higher serum bicarbonate levels. Conclusions: We observed a longitudinal association between MA and lower height z score. Additionally, persistent alkali therapy use was associated with better height z scores. Future clinical trials of alkali therapy need to evaluate this relationship prospectively.
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: Jérôme Harambat; Kevin Kunzmann; Karolis Azukaitis; Aysun K Bayazit; Nur Canpolat; Anke Doyon; Ali Duzova; Anna Niemirska; Betul Sözeri; Daniela Thurn-Valsassina; Ali Anarat; Lucie Bessenay; Cengiz Candan; Amira Peco-Antic; Alev Yilmaz; Sibylle Tschumi; Sara Testa; Augustina Jankauskiene; Hakan Erdogan; Alejandra Rosales; Harika Alpay; Francesca Lugani; Klaus Arbeiter; Francesca Mencarelli; Aysel Kiyak; Osman Dönmez; Dorota Drozdz; Anette Melk; Uwe Querfeld; Franz Schaefer Journal: Kidney Int Date: 2017-07-18 Impact factor: 10.612
Authors: Nancy M Rodig; Kelly C McDermott; Michael F Schneider; Hilary M Hotchkiss; Ora Yadin; Mouin G Seikaly; Susan L Furth; Bradley A Warady Journal: Pediatr Nephrol Date: 2014-04-12 Impact factor: 3.714
Authors: Susan L Furth; Stephen R Cole; Marva Moxey-Mims; Frederick Kaskel; Robert Mak; George Schwartz; Craig Wong; Alvaro Muñoz; Bradley A Warady Journal: Clin J Am Soc Nephrol Date: 2006-07-19 Impact factor: 8.237
Authors: Christopher B Pierce; Alvaro Muñoz; Derek K Ng; Bradley A Warady; Susan L Furth; George J Schwartz Journal: Kidney Int Date: 2020-12-08 Impact factor: 18.998