We evaluated 3234 children with CRI (defined as a GFR < 75ml/M2/min) who were entered into the NAPRTCS registry. It was our intent to determine whether children with CRI and short stature (defined as having a height standard deviation score (HtSDS) of <-1.88) were receiving optimal therapy and having maximal correction of their height deficit. This is important since neither dialysis or transplant initiated beyond five years of age have the potential for “catch up ” growth. Eighteen hundred and seventy-eight patients had been followed for at least 12 months, of those 678 were short at baseline. The mean change from baseline HtSDS (DHtSDS) for all 678 patients at 6, 12 and 18 months was.20,.32 and.36 respectively. These data are reflected for each yearly cohort in the table. Since the mean DHtSDS were positive some “catch-up” growth is occurring in this population, however, correction of the height deficit is not as great as noted in recent published reports utilizing recombinant human growth hormone (rhGH) in short children with CRI. Factors which effect growth in CRI were analyzed and are presented in the table.

Table 1 No caption available.
Full size table

These data suggest that a substantial number of patients that have been followed for 12 months remain short and a significant percentage are anemic, acidotic, have borderline serum calcium levels and may be malnourished. Of interest, the percent rhGH utilization was only 20, 26 and 14.7 percent respectively in the 1994,1995 and 1996 cohorts of short patients. These data clearly indicate that optimal therapy is not being provided to a significant number of short children with CRI.

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