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Growth after pediatric kidney transplantation
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Introdução: O atraso estaturo-ponderal é umas das principais complicações da
doença renal crónica em idade pediátrica. Contudo, mesmo após o transplante renal, cerca de 50% das crianças não atingem a estatura esperada na idade adulta. Os objetivos deste estudo foram avaliar o crescimento após transplante e identificar fatores que o possam influenciar.
Métodos: Foi realizado um estudo observacional retrospetivo. Foram analisados os processos clínicos de todos os doentes submetidos a transplante renal nos últimos 25 anos (n=149) e foram realizadas chamadas telefónicas para obtenção de dados em falta.
Os z-scores de estatura e índice de massa corporal (IMC) foram examinados à altura do transplante, 3 meses, 6 meses, 1 ano e 5 anos após o transplante renal e a estatura final na idade adulta, através das curvas e tabelas de crescimento da OMS. Ademais, dados relativos à duração da doença previamente ao transplante, técnica de substituição da
função renal, administração de hormona de crescimento, suporte nutricional, estatura
alvo, função renal e dose cumulativa de corticosteroides foram obtidos.
Resultados: A análise dos z-scores revelou uma recuperação da estatura
estatisticamente significativa aos 6 meses (p=0,006), 1 ano (p<0,001), 5 anos após transplante (p<0,001) e na idade adulta (p=0,012). Houve também uma recuperação
significativa do IMC em todos os momentos avaliados (p<0,001). A taxa de filtração glomerular correlacionou-se de forma positiva e significativa com a estatura (p=0,006)
e o IMC (p=0,006). O tratamento com hormona do crescimento não teve impacto na
estatura à data do transplante (p=0,182). A utilização de gastrostomia não teve impacto
significativo na estatura (p=0,167) nem no IMC (p=0,086) à data do transplante. A
duração da doença renal até ao transplante não demonstrou influenciar a estatura (r=-
0,087, p=0,464) e o IMC (r=-0,144, p=0,225) na idade adulta. Ademais, a dose cumulativa
de corticosteroides a que são sujeitos não demonstrou impacto na estatura (r=-0,080,
p=0,538) e IMC (r=-0,155, p=0,229) na idade adulta. A evidenciar, temos o facto de que, em média, a estatura destas crianças na idade adulta foi 8,82 cm mais baixa do que a
estatura-alvo.Conclusão: Apesar dos resultados encorajadores do nosso trabalho relativamente à
recuperação da estatura após o transplante renal, os resultados permanecem longe do
que seria desejável. Desta forma, estratégias devem ser estudadas e aplicadas,
nomeadamente, a utilização sistemática de gastrostomia. Ademais, deve ser feito um controlo regrado do IMC de modo a evitar um excessivo ganho ponderal, que se associa
a um aumento do risco cardiovascular.
Background: Growth failure is one of the major complications of pediatric chronic kidney disease (CKD). However, even after KT, up to 50% of patients fail to attain expected final height by the time they transition to adult services. The aims of this project were to assess longitudinal growth after KT and to identify factors that influence it. Methods: A retrospective observational study was performed. We reviewed the clinical records of all patients who underwent KT in the last 25 years in a single center (n=149) and performed phone interviews in order to obtain further data. Height-for-age and sex and BMI-for-age and sex were examined at transplant, 3 months, 6 months, 1 year and 5 years post-transplant and at final adult height, using WHO growth standards. Data regarding duration of disease prior to transplant, type of dialysis, administration of pretransplant recombinant human growth hormone (rhGH), nutritional support, target height, glomerular filtration rate (GFR) and cumulative corticosteroid dose were obtained as well. Results: Height z-scores showed catch-up growth at 6 months (p=.006), 1 year (p<.001), 5 years after transplantation (p<.001) and on transition to adult care (p=.012). Regarding BMI z-scores, a significant increase was also detected at all time-point assessments (p<.001). GFR was significantly associated with height z-score (p=.006) and BMI z-score (p=.006). In our cohort, treatment with rhGH had no impact on height zscore at transplant (p=.182). Use of gastrostomy feeding tube had no statistically significant impact on height z-score (p=.167) and BMI z-score (p=.086) at transplantation, although only 6% (n=6) of our patients used gastrostomy feeding tube. Disease duration until transplantation had, also, no influence on height z-score (r=-.087, p=.464) or BMI z-score (r=-.144, p=.225) at adult care transition. Furthermore, cumulative corticosteroid dose had no influence on height z-score (r=-.080, p=.538) or BMI z-score (r=-.155, p=.229) at transition to adult care. Importantly, in our cohort height in adulthood was 8.82 cm lower, on average, than the target height.Conclusion: Although the encouraging results regarding catch-up growth after KT presented in this cohort, results remain far from optimum. Therefore, strategies must be thought, including systematic use of gastrostomy tube feeding. Furthermore, closely monitoring of BMI is important in order to avoid excessive weight gain as it is associated with a greater cardiovascular risk.
Background: Growth failure is one of the major complications of pediatric chronic kidney disease (CKD). However, even after KT, up to 50% of patients fail to attain expected final height by the time they transition to adult services. The aims of this project were to assess longitudinal growth after KT and to identify factors that influence it. Methods: A retrospective observational study was performed. We reviewed the clinical records of all patients who underwent KT in the last 25 years in a single center (n=149) and performed phone interviews in order to obtain further data. Height-for-age and sex and BMI-for-age and sex were examined at transplant, 3 months, 6 months, 1 year and 5 years post-transplant and at final adult height, using WHO growth standards. Data regarding duration of disease prior to transplant, type of dialysis, administration of pretransplant recombinant human growth hormone (rhGH), nutritional support, target height, glomerular filtration rate (GFR) and cumulative corticosteroid dose were obtained as well. Results: Height z-scores showed catch-up growth at 6 months (p=.006), 1 year (p<.001), 5 years after transplantation (p<.001) and on transition to adult care (p=.012). Regarding BMI z-scores, a significant increase was also detected at all time-point assessments (p<.001). GFR was significantly associated with height z-score (p=.006) and BMI z-score (p=.006). In our cohort, treatment with rhGH had no impact on height zscore at transplant (p=.182). Use of gastrostomy feeding tube had no statistically significant impact on height z-score (p=.167) and BMI z-score (p=.086) at transplantation, although only 6% (n=6) of our patients used gastrostomy feeding tube. Disease duration until transplantation had, also, no influence on height z-score (r=-.087, p=.464) or BMI z-score (r=-.144, p=.225) at adult care transition. Furthermore, cumulative corticosteroid dose had no influence on height z-score (r=-.080, p=.538) or BMI z-score (r=-.155, p=.229) at transition to adult care. Importantly, in our cohort height in adulthood was 8.82 cm lower, on average, than the target height.Conclusion: Although the encouraging results regarding catch-up growth after KT presented in this cohort, results remain far from optimum. Therefore, strategies must be thought, including systematic use of gastrostomy tube feeding. Furthermore, closely monitoring of BMI is important in order to avoid excessive weight gain as it is associated with a greater cardiovascular risk.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Crescimento Doença renal crónica Transplante Pediatria