Anthropometric measures and risk of death in children with end-stage renal disease

doi:10.1053/ajkd.2000.17674

American Journal of Kidney Diseases

Volume 36, Issue 4, October 2000, Pages 811-819

https://doi.org/10.1053/ajkd.2000.17674 Get rights and content

Abstract

We evaluated the association between anthropometric measurements and death among pediatric patients with end-stage renal disease (ESRD) using data from the Pediatric Growth and Development Special Study (PGDSS) from the US Renal Data System. Height, growth velocity, and body mass index (BMI) were used for the analysis of 1,949 patients in the PGDSS. To standardize these measurements, SD scores (SDSs) were calculated using population data from the Third National Health and Nutrition Examination Survey. Using Cox proportional hazards models, we assessed the association between anthropometric measures and death, controlling for demographic factors and stratifying by age. Multivariate analysis showed that each decrease by 1 SDS in height was associated with a 14% increase in risk for death (adjusted relative risk [aRR], 1.14; 95% confidence interval [CI], 1.02 to 1.27; P = 0.017). For each 1 SDS decrease in growth velocity among patients in our sample, the risk for death increased by 12% (aRR, 1.12; 95% CI, 1.00 to 1.25; P = 0.043). There was a statistically significant U-shaped association between BMI and death (P = 0.001), with relatively low and high BMIs associated with an increased risk for death. In children with ESRD, growth delay and extremes in BMI are associated with an increased risk for mortality.

Section snippets

Patient population and data collection

This study used data collected by the PGDSS from the USRDS. Details of the study design are described elsewhere.¹³ In brief, the PGDSS was designed to establish a baseline for assessing growth and sexual maturation by renal replacement modality among pediatric patients with ESRD. Eligible subjects included prevalent Medicare patients with ESRD aged 18 years or younger treated at a single dialysis or transplant unit for at least 30 consecutive days during 1990. From December 1, 1989, through

Results

Characteristics of the study population and patients who were excluded are listed in Table 1.

. Characteristics of Included and Excluded Pediatric Patients With ESRD

Covariate	Study Sample		Excluded
Covariate	Available Cases (n = 1,949)	Frequency (%)	Available Cases (n = 1,118)	Frequency (%)
Sex	1,949		1,113
Male	1,147	59	626	56.2
Race	1,949		1,107
White	1,468	75.3	701	63.3
Black	378	19.4	262	23.7
Other	103	5.3	144	13.0
Age (y)	1,949		613
0-5	190	9.8	35	6.9
6-14	821	42.1	130	25.7
15-18	938	48.1	340	67.3
Duration of ESRD* (y)	1,949		505
<2	888	45.6	237	46.9
2-5	601

Discussion

Mean height, linear growth velocity, and BMI of children and adolescents with a history of ESRD were less than the mean of children in the general pediatric population. In addition, our results show that height, linear growth velocity, and BMI are predictors of mortality in pediatric dialysis and transplant patients. As height and growth velocity scores decrease, the risk for death increases. The greatest risk for mortality relative to BMI was seen with the upper and lower extremes of BMI.

Our

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Citation Excerpt :
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^*: Supported in part by grant no. T DK 07662-08 from the Pediatric Nephrology Molecular Biology Training; and the Veterans Administration Research Service.

^**: Address reprint request Catherine Stehman-Breen, MD, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108. E-mail: [email protected]

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Original InvestigationAnthropometric measures and risk of death in children with end-stage renal disease*,**

Abstract

Section snippets

Patient population and data collection

Results

Discussion

Am J Kidney Dis

Kidney Int

J Pediatr

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

J Ren Nutr

Kidney Int

Kidney Int

Am J Clin Nutr

Kidney Int

Kidney Int

US Renal Data System: USRDS 1999 Annual Data Report. Patient mortality and survival in ESRD

Am J Kidney Dis

Annual summary of vital statistics-1997

Pediatrics

An update on peritoneal dialysis and hemodialysis in the pediatric population

Curr Opin Pediatr

Mortality of chronic hemodialysis and renal transplantation

Pediatrics

Mortality trends in pediatric patients with chronic renal failure

Pediatr Nephrol

Cause of death for children on chronic dialysis: A 20-year analysis

Dial Transplant

15 Years of experience with renal replacement therapy in patients starting therapy before age 20

Int J Artif Organs

Outcome of infants on chronic peritoneal dialysis

Adv Perit Dial

Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes

J Am Soc Nephrol

Overweight as another nutritional factor for long-term survival of non-diabetic hemodialysis patients

Clin Nephrol

US Renal Data System: USRDS 1995 Annual Data Report

Am J Kidney Dis

Third National Health and Nutrition Examination Survey (NHANES III)

The impact of comorbid and sociodemographic factors on access to renal transplantation

JAMA

Race and socioeconomic factors influencing early placement on the kidney transplant waiting list

J Am Soc Nephrol

Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant

N Engl J Med

Original Investigation
Anthropometric measures and risk of death in children with end-stage renal disease*,**