Poor growth, delayed puberty and heart problems plague kids with mild kidney disease

Children with only mildly to moderately impaired kidney function experience poor growth, delays in puberty, and heart problems, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (JASN). Therapies for these conditions might help slow the progression of kidney disease in children.

Heart disease causes almost 35% of deaths in young adults with chronic kidney disease. What factors during childhood might contribute, and how serious do kidney problems have to be before they trigger damage to the heart? To find out, Susan Furth, MD, PhD, of the Children’s Hospital of Philadelphia and her colleagues studied 586 children with chronic kidney disease.

Among the major findings:

  * Poor growth, delayed puberty, metabolic problems (such as pH and electrolyte imbalances), and high blood pressure often occurred in children with only mildly or moderately impaired kidneys.
  * Even when children took medications to treat some of these conditions, they were more common as kidney function decreased.

“We were hoping to identify risk factors for CKD progression and see if these can be targeted to slow the decline of kidney function and prevent its complications,” said Dr. Furth. “Our findings suggest that more aggressive interventions to improve blood pressure and metabolic abnormalities may be areas where interventions could slow chronic kidney disease progression and decrease the prevalence of cardiovascular disease in children and young adults with chronic kidney disease. The next step will be to design clinical trials of these interventions based on our findings.”

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Study co-authors include Alison Abraham, PhD, Judith Jerry-Fluker (Johns Hopkins Bloomberg School of Public Health; George Schwartz, MD (University of Rochester Medical Center); Mark Benfield, MD (Pediatric Nephrology of Alabama); Frederick Kaskel, MD, PhD (Albert Einstein Yeshiva University); Craig Wong, MD (University of New Mexico, Albuquerque); Robert Mak, MD, PhD (University of California at San Diego); Marva Moxey-Mims, MD (National Institutes of Health); and Bradley Warady, MD (University of Missouri-Kansas City School of Medicine).

Disclosures: The CKiD prospective cohort study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Neurologic Disorders and Stroke, National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute. The CKiD prospective cohort study has clinical coordinating centers (principal investigators) at Children’s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia and the University of Pennsylvania (Susan Furth, MD, PhD), a Central Biochemistry Laboratory at the University of Rochester (George Schwartz, MD) and data coordinating center at the Johns Hopkins Bloomberg School of Public Health (Alvaro Muñoz, PhD).

The article, entitled “Metabolic Abnormalities, CVD Risk Factors and GFR Decline in Children with CKD,” will appear online at http://cjasn.asnjournals.org/ on doi:10.2215/CJN.07100810

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Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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Contact: Adrienne Lea
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American Society of Nephrology