ESPN 50th Annual Meeting

ESPN 2017

Marjolein Bonthuis 1 Jaap W. Groothoff 2 Anna Bjerre 3 Constantinos J. Stefanidis 4 Jérôme Harambat 5 Kitty J. Jager 1

1- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
2- Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
3- Oslo University Hospital Rikshospitalet, Department of Pediatrics, Oslo, Norway
4- Department of Nephrology, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
5- Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France

 We aimed to study associations of height and body mass index (BMI) and access to transplantation and risk of death during the entire course of paediatric RRT.

Material and methods:

We included all children < 20 years starting RRT in 31 European countries between 1995 and 2014 for whom anthropometric data were reported to the ESPN/ERA-EDTA Registry.

We defined short and tall stature as a height SDS < -1.88 and > 1.88. BMI was expressed according to height-age.

Associations with outcomes were assessed using Cox regression models with time-dependent covariates and adjusted for country, age, sex, primary renal disease, and treatment modality, where relevant.


After a median follow-up of 4.9 years [IQR: 2.3-7.9], 279 patients out of 6255 patients had died. Causes of death were known for 69% of patients, and infection- or cardiac related deaths were most common (both 24%). Compared to children with normal stature, all-cause mortality risk was higher among short children (aHR: 2.05, 95% CI: 1.58-2.67), but not among tall ones. Short patients particularly showed a higher risk of infection-related death (aHR: 3.78, 95% CI: 2.10-6.80). Compared to normal weight subjects, underweight patients showed a higher all-cause mortality risk (aHR: 1.94, 95% CI: 1.35-2.78) and a lower access to transplantation (aHR: 0.80, 95% CI: 0.69-0.92). We also found a trend towards lower transplantation rates for obese patients
(aHR: 0.86, 95% CI: 0.74-1.01). Furthermore, obese patients were more likely to die from cardiac causes (aHR: 3.09, 95% CI: 1.35-7.08) compared to normal weight patients. 


We found a higher mortality risk among paediatric RRT patients with short stature and those who were underweight. Furthermore, extremes in BMI were associated with a lower access to transplantation. Our results highlight the need for careful nutritional management and timely intervention in these patients.