Growth impairment in children with CKD have reduced Hb levels

A new study by Oleh Akchurin and team showed that hemoglobin reduction is related with development impairment in children with mild to severe nonglomerular chronic kidney disease (CKD) over time, even before hemoglobin levels approach the existing anemia cutoffs in this cohort. The findings of this study were published in the American Journal of Kidney Diseases. 

Anemia and statural growth retardation are both common in children with nonglomerular chronic renal disease and are linked to a lower quality of life as well as higher morbidity and mortality. Nevertheless, no longitudinal investigations have found a link between anemia and statural growth in this group. As a result, this study was carried out in order to investigate the Longitudinal Connection among anemia and statural growth in CKD patients.

The CKD in Children (CKiD) project is a multicenter prospective cohort study that has been running for over 15 years. Participants in this study were CKiD patients less than 22 years old with nonglomerular CKD who had not achieved their ultimate adult height. (1) multivariable repeated measures paired person-visit analysis and (2) multivariable repeated measures linear mixed model analysis were used to quantify the connection between hemoglobin and height. Age, gender, estimated glomerular filtration rate, acidosis, body mass index, and medication usage were all taken into account in both models.

The key findings of this study were:

During the course of the study, 67% of the 510 individuals exhibited deteriorating hemoglobin z score trajectories, which covered 1,763 person-visits. 

Average hemoglobin z scores less than 1.0 were independently related with considerable development impairment at the second study visit, with height z score reduction ranging from 0.24 to 0.35. 

Notably, hemoglobin z scores less than 1.0 corresponded to hemoglobin values greater than those used as anemia cutoffs in the KDIGO clinical practice guideline for anemia in CKD in 50% of patients. 

The amplitude of the connection peaked in participants aged 9 years when stratified by age.

In accordance with paired-visit studies, our mixed model analysis revealed that a drop in hemoglobin z score across the follow-up period was linked with a statistically significant contemporaneous decrease in height z score among participants with a baseline hemoglobin z score less than 1.0.

To conclude, in children with mild to severe nonglomerular CKD, hemoglobin decrease is related with impaired statural development.

Reference: 

Akchurin, O., Molino, A. R., Schneider, M. F., Atkinson, M. A., Warady, B. A., & Furth, S. L. (2023). Longitudinal Relationship Between Anemia and Statural Growth Impairment in Children and Adolescents With Nonglomerular CKD: Findings From the Chronic Kidney Disease in Children (CKiD) Study. In American Journal of Kidney Diseases (Vol. 81, Issue 4, pp. 457-465.e1). Elsevier BV. https://doi.org/10.1053/j.ajkd.2022.09.019