Growth and Growth Hormone Therapy in Children with CKD ADC 2016 PDF
Preview Growth and Growth Hormone Therapy in Children with CKD ADC 2016
Growth and Growth Hormone Therapy in Children with CKD ADC 2016 John D Mahan, MD Professor of Pediatrics Nationwide Children’s/the Ohio State University College of Medicine ………………..…………………………………………………………………………………………………………………………………….. Overview Background •Growth in Patients with CKD •Causes of Growth Failure in CKD Growth Assessment and Evaluation for Growth Hormone Treatment in Children with CKD Growth Hormone Therapy in Children with CKD: Benefits, Risks Guidelines for Evaluating the Growth Response to rhGH Therapy Growth: the Paramount Concern! ………………..…………………………………………………………………………………………………………………………………….. 2 1. Growth is one of the MOST important issues that children with CKD confront! ………………..…………………………………………………………………………………………………………………………………….. What Concerns Children and Parents About Living with CKD*? Reynolds JM Arch Dis Child. 1995;73:36-42. Percent (%) ………………..…………………………………………………………………………………………………………………………………….. Social Outcome Following Renal Transplantation is Greatly Influenced by Adult Height Adult height was significantly correlated with: Characteristic P value Year of transplantation .04 Higher educational level achieved <.001 Higher rate of paid employment .02 Greater likelihood of marriage <.0001 Greater likelihood of independent living .0003 Broyer M, Transplantation 2004: 77:1033-1037. Height Dissatisfaction - Impacts Quality of Life 40 Mean adult height SDS score: 35 –1.56 ± 1.55 t h g 30 Height satisfaction correlated i se lh a ut significantly with height SDS dul 25 vid ia score (r = 0.42; P = .006) d nh f iwit 20 o Quality of life correlated d t ne cesfi 15 significantly with height ri eat Ps satisfaction s 10 i d (r = 0.41; P = .008) 5 0 Adults with Healthy childhood- age-matched onset ESRD controls Rosenkranz J, Pediatr Nephrol 2005;20:1288-1294. Growth Patterns in Patients with CKD Height Child Without CKD Child With CKD Birth Puberty Adapted from Betts et al. Br Med J. 1974;2:189-193. ………………..…………………………………………………………………………………………………………………………………….. Growth in Patients with CKD Patient 1 Patient 2 8 Growth Failure in Children with CKD is Associated with Poorer Survival Height in 2,306 patients with CKD – NAPRTCS At initiation of dialysis - 1992-2001 100 Age >1, Z > -2.5 90 ) Age > 1, Z<-2.5 %80 ( Age 0-1, Z > -2.5 l a 70 v i v r Age 0-1, Z < -2.5 u60 S 50 40 30 0 1 2 3 Years Furth S, Pediatrics 2002 Growth Failure in Children on Dialysis is Associated with Poorer Survival 1,112 patients < 18 yo ESRD – USRDS Tanner Stage I to IV, ht data Jan-Dec 1990 100 Normal growth ) 95 % ( l 90 a v i v r 85 Moderate growth failure u S 80 Severe growth failure 75 0 250 500 750 1000 1250 1500 1750 2000 Days Furth S.. Pediatr Nephrol 2002
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