Declining hemoglobin linked with growth impairment among children with CKD
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Key takeaways:
- Hemoglobin decline correlates with growth impairment.
- Researchers recommend updated guidelines for anemia and short stature management in children with chronic kidney disease.
Over time, a declining hemoglobin z score correlates with impaired height among children with mild to moderate nonglomerular chronic kidney disease, according to data published in the American Journal of Kidney Diseases.
Moreover, investigators found impaired growth occurs even before hemoglobin levels reach the threshold used to define anemia in children.
“Both anemia and short stature are common complications of CKD in children. In children without CKD, anemia has been shown to impair physical development; however, the relationship between anemia and growth in children with CKD remains unclear,” Oleh Akchurin, MD, PhD, from the department of pediatrics at Weill Cornell Medicine and New York-Presbyterian Hospital, and colleagues wrote.
Deriving data from the Chronic Kidney Disease in Children (CKiD) cohort study, researchers examined findings for 510 participants younger than 22 years with nonglomerular CKD who had not yet reached adult height. With age-, sex- and race-specific hemoglobin z score serving as the exposures, researchers considered the age and sex-specific height z score the primary outcomes. Using multivariable repeated measures paired person-visit analyses (1,763 visit pairs) and multivariable repeated measures linear mixed-model analyses (2,727 person-visits), researchers determined the association between hemoglobin and height.
During the follow-up period, 67% of patients showed declining hemoglobin z scores. With a hemoglobin z score of at least zero serving as the average, scores less than 1independently correlated with significant growth impairment at a patient’s next study visit. Additionally, this was associated with a height z score decline between 0.24 to 0.35.
Among half of the cases in which scores averaged less than 1, researchers noted the scores were higher than those used as the threshold to define anemia. Therefore, researchers concluded that impaired growth occurred among patients before the hemoglobin scores reached the Kidney Disease: Improving Global Outcomes cutoff for anemia.
Analyses revealed the association peaked among 9-year-old patients.
“In conclusion, hemoglobin decline is associated with statural growth impairment in children with mild to moderate CKD of nonglomerular origin. Hemoglobin z scores of less than 1 in these children should trigger an evaluation of anemia,” Akchurin and colleagues wrote. “Development of hemoglobin targets for anemia treatment in children with CKD should consider the association between hemoglobin and growth, which may result in higher hemoglobin targets than those that have been set for adults with CKD. Finally, growth outcomes should be measured in future interventional studies testing novel approaches for the treatment of anemia in pediatric CKD, especially in the pre-adolescent and early adolescent age groups.”
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