title: Patterns of growth after kidney transplantation among children with ESRD.
abstract: OBJECTIVE
  Poor linear growth is a frequent complication of CKD. This study evaluated the effect of kidney transplantation on age-related growth of linear body segments in pediatric renal transplant recipients who were enrolled from May 1998 until August 2013 in the CKD Growth and Development observational cohort study.
  
  
  METHODS
  Linear growth (height, sitting height, arm and leg lengths) was prospectively investigated during 1639 annual visits in a cohort of 389 pediatric renal transplant recipients ages 2-18 years with a median follow-up of 3.4 years (interquartile range, 1.9-5.9 years). Linear mixed-effects models were used to assess age-related changes and predictors of linear body segments.
  
  
  RESULTS
  During early childhood, patients showed lower mean SD scores (SDS) for height (-1.7) and a markedly elevated sitting height index (ratio of sitting height to total body height) compared with healthy children (1.6 SDS), indicating disproportionate stunting (each P<0.001). After early childhood a sustained increase in standardized leg length and a constant decrease in standardized sitting height were noted (each P<0.001), resulting in significant catch-up growth and almost complete normalization of sitting height index by adult age (0.4 SDS; P<0.01 versus age 2-4 years). Time after transplantation, congenital renal disease, bone maturation, steroid exposure, degree of metabolic acidosis and anemia, intrauterine growth restriction, and parental height were significant predictors of linear body dimensions and body proportions (each P<0.05).
  
  
  CONCLUSIONS
  Children with ESRD present with disproportionate stunting. In pediatric renal transplant recipients, a sustained increase in standardized leg length and total body height is observed from preschool until adult age, resulting in restoration of body proportions in most patients. Reduction of steroid exposure and optimal metabolic control before and after transplantation are promising measures to further improve growth outcome.
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany;
authors.forename: Doris
authors.initials: D
authors.lastname: Franke
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany;
authors.forename: Lena
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany;
authors.forename: Rena
authors.initials: R
authors.lastname: Steffens
authors.affiliation: Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia; and.
authors.forename: Leo
authors.initials: L
authors.lastname: Pavičić
authors.affiliation: Department of Pediatric Nephrology, Charité University Hospital, Berlin, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Gellermann
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany;
authors.forename: Kerstin
authors.initials: K
authors.lastname: Froede
authors.affiliation: Department of Pediatric Nephrology, Charité University Hospital, Berlin, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Querfeld
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany;
authors.forename: Dieter
authors.initials: D
authors.lastname: Haffner
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany; zivicnjak.miroslav@mh-hannover.de.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Živičnjak
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000367:Age Factors; D001827:Body Height; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006130:Growth Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids
keywords: chronic kidney disease; pediatric kidney transplantation; pediatric nephrology; pediatrics; renal function