Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement.
Growth failure is a clinically important issue in children with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. Many factors contribute to impaired growth in these children, including abnormalities in the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis, malnutrition, acidosis, and renal bone disease. The management of growth failure in children with CKD is complicated by the presence of other disease-related complications requiring medical intervention. Despite evidence of GH efficacy and safety in this population, some practitioners and families have been reluctant to institute GH therapy, citing an unwillingness to comply with daily injections, reimbursement difficulties, or impending renal transplantation. Suboptimal attention to growth failure management may be further compounded by a lack of clinical guidelines for the appropriate assessment and treatment of growth failure in these children. This review of growth failure in children with CKD concludes with an algorithm developed by members of the consensus committee, outlining their recommendations for appropriate steps to improve growth and overall health outcomes in children with CKD.
Mahan
John D
JD
Department of Pediatrics, Division of Pediatric Nephrology, The Ohio State University COMPH, Columbus, OH, USA. MahanJ@pediatrics.ohio-state.edu
Warady
Bradley A
BA
D001827:Body Height / Q000187:drug effects; D002648:Child; D006130:Growth Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000172:deficiency / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis
D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I