ESPN 50th Annual Meeting

ESPN 2017


 
ANTHROPOMETRY AND CLINICAL OUTCOMES IN PAEDIATRIC RRT - RESULTS FROM THE ESPN/ERA-EDTA REGISTRY
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
 
Introduction:

 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.

Results:

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. 

Conclusions:

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.