Division of Pediatric Nephrology, Emory University, 2015 Uppergate Drive, NE, Atlanta, GA 30322, USA.
Clin J Am Soc Nephrol. 2011 Jan;6(1):14-21. doi: 10.2215/CJN.08481109. Epub 2010 Oct 28.
Poor linear growth is a well described complication of chronic kidney disease (CKD). This study evaluated whether abnormal birth history defined by low birth weight (LBW; <2500 g), prematurity (gestational age <36 weeks), small for gestational age (SGA; birth weight <10th percentile for gestational age), or intensive care unit (ICU) at birth were risk factors for poor growth outcomes in children with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Growth outcomes were quantified by age-sex-specific height and weight z-scores during 1393 visits from 426 participants of the Chronic Kidney Disease in Children Study, an observational cohort of children with CKD. Median baseline GFR was 42.9 ml/min per 1.73 m(2), 21% had a glomerular diagnosis, and 52% had CKD for ≥ 90% of their lifetime.
A high prevalence of LBW (17%), SGA (14%), prematurity (12%), and ICU after delivery (40%) was observed. Multivariate analyses demonstrated a negative effect of LBW (-0.43 ± 0.14; P < 0.01 for height and -0.37 ± 0.16; P = 0.02 for weight) and of SGA (-0.29 ± 0.16; P = 0.07 for height and -0.41 ± 0.19; P = 0.03 for weight) on current height and weight. In children with glomerular versus nonglomerular diagnoses, the effect of SGA (-1.08 versus -0.18; P = 0.029) on attained weight was more pronounced in children with a glomerular diagnosis.
LBW and SGA are novel risk factors for short stature and lower weight percentiles in children with mild to moderate CKD independent of kidney function.
慢性肾脏病（CKD）患者的线性生长不良是一种常见并发症。本研究旨在评估出生时体重低（LBW，<2500g）、早产（胎龄<36 周）、小于胎龄儿（SGA，出生体重<胎龄第 10 百分位数）或出生后入住重症监护病房（ICU）等异常出生史是否为 CKD 患儿生长不良的危险因素。
设计、地点、参与者和测量：通过 426 名慢性肾脏病儿童研究（CKD 儿童观察队列）参与者的 1393 次就诊，采用年龄性别特异性身高和体重 z 评分来量化生长结局。中位基线肾小球滤过率（GFR）为 42.9ml/min/1.73m²，21%为肾小球疾病，52%患儿 CKD 持续时间≥90%。
观察到 LBW（17%）、SGA（14%）、早产（12%）和分娩后 ICU（40%）的高患病率。多变量分析显示，LBW（身高-0.43±0.14；P<0.01，体重-0.37±0.16；P=0.02）和 SGA（身高-0.29±0.16；P=0.07，体重-0.41±0.19；P=0.03）对当前身高和体重均有负面影响。在肾小球疾病与非肾小球疾病患儿中，SGA（-1.08 与-0.18；P=0.029）对体重的影响在肾小球疾病患儿中更为显著。
LBW 和 SGA 是轻度至中度 CKD 患儿身材矮小和体重百分位数较低的新危险因素，与肾功能无关。
