Division of Nephrology, Children's National Hospital, Washington, DC.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Kidney360. 2022 Feb 9;3(4):666-676. doi: 10.34067/KID.0005402021. eCollection 2022 Apr 28.
Poor linear growth is a consequence of chronic kidney disease (CKD) that has been linked to adverse outcomes. Metabolic acidosis (MA) has been identified as a risk factor for growth failure. We investigated the longitudinal relationship between MA and linear growth in children with CKD and examined whether treatment of MA modified linear growth.
To describe longitudinal associations between MA and linear growth, we used serum bicarbonate levels, height measurements, and standard deviation (z scores) of children enrolled in the prospective cohort study Chronic Kidney Disease in Children. Analyses were adjusted for covariates recognized as correlating with poor growth, including demographic characteristics, glomerular filtration rate (GFR), proteinuria, calcium, phosphate, parathyroid hormone, and CKD duration. CKD diagnoses were analyzed by disease categories, nonglomerular or glomerular.
The study population included 1082 children with CKD: 808 with nonglomerular etiologies and 274 with glomerular etiologies. Baseline serum bicarbonate levels ≤22 mEq/L were associated with worse height z scores in all children. Longitudinally, serum bicarbonate levels ≤18 and 19-22 mEq/L were associated with worse height z scores in children with nonglomerular CKD causes, with adjusted mean values of -0.39 (95% CI, -0.58 to -0.2) and -0.17 (95% CI, -0.28 to -0.05), respectively. Children with nonglomerular disease and more severe GFR impairment had a higher risk for worse height z score. A significant association was not found in children with glomerular diseases. We also investigated the potential effect of treatment of MA on height in children with a history of alkali therapy use, finding that only persistent users had a significant positive association between their height z score and higher serum bicarbonate levels.
We observed a longitudinal association between MA and lower height z score. Additionally, persistent alkali therapy use was associated with better height z scores. Future clinical trials of alkali therapy need to evaluate this relationship prospectively.
慢性肾脏病（CKD）会导致线性生长不良，进而导致不良后果。代谢性酸中毒（MA）已被确定为生长障碍的危险因素。我们研究了 CKD 儿童中 MA 与线性生长之间的纵向关系，并探讨了 MA 的治疗是否会改变线性生长。
为了描述 MA 与线性生长之间的纵向关联，我们使用了血清碳酸氢盐水平、身高测量值和参加前瞻性队列研究慢性肾脏病儿童的身高 z 分数。分析调整了与生长不良相关的协变量，包括人口统计学特征、肾小球滤过率（GFR）、蛋白尿、钙、磷、甲状旁腺激素和 CKD 持续时间。CKD 诊断按疾病类别分析，即非肾小球或肾小球。
该研究人群包括 1082 名 CKD 儿童：808 名非肾小球病因和 274 名肾小球病因。所有儿童的基线血清碳酸氢盐水平≤22 mEq/L 与较差的身高 z 评分相关。纵向来看，血清碳酸氢盐水平≤18 和 19-22 mEq/L 与非肾小球性 CKD 病因儿童的身高 z 评分较差相关，调整后的平均值分别为-0.39（95%CI，-0.58 至-0.2）和-0.17（95%CI，-0.28 至-0.05）。肾小球疾病儿童中未发现显著相关性。我们还研究了 MA 治疗对碱治疗史儿童身高的潜在影响，发现只有持续使用者的身高 z 分数与更高的血清碳酸氢盐水平之间存在显著正相关。
我们观察到 MA 与较低的身高 z 评分之间存在纵向关联。此外，持续使用碱疗法与更好的身高 z 评分相关。未来碱疗法的临床试验需要前瞻性地评估这种关系。
