27/02/2018. Releasing growth potential in children with CKD. Growth failure. Percentiles and SDS

Transcription

1 Releasing growth potential in children with CKD Pearl Pugh Paediatric Renal Dietitian Nottingham children s Hospital and Health Science PhD candidate This researcher was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC EM). The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Growth failure Percentiles and SDS 1

2 Causes of growth failure in CKD How big is the problem? Final adult height 2

3 Final adult male height Final adult female height Impact of reduced adult height potential 3

4 Final adult height Final adult height Final adult female height 4

5 Impact of reduced adult height potential Suboptimal Growth hormone and Quality of life 5

6 Main reasons for improvement in growth Adequate dialysis Improved growth on HDF Fischbach et al (2010) 6

7 3H HDF, heart and Height study Use and efficacy of GH Growth hormone and gross national income 7

8 Early bone changes in paediatric CKD Fibroblast Growth Hormone - 23 Klotho gene 8

9 Klotho/FGF-23 axis Novel management of FGF-23 Early dietary phosphate intervention 9

10 Nutritional status Betts& Magrath (1974) Main factors affecting growth and intake 10

11 NAPRTCS Seikaly et al (2006) CKiD study Greenbaum et al (2011) Factors affecting appetite/growth 11

12 Sooner is better Infancy phase of growth Nutritional support 12

13 Gastrostomy or nasogastric? SDS for height Childhood phase of growth 13

14 Mekahli et al (2010) Case study Obesity 14

15 Intensive dietetic input Take home message The best chance of optimising growth potential Aggressive daily dialysis (HDF) Recombinant human growth hormone Early dietetic referral to a specialist renal dietitian Early treatment of metabolic bone disease Early commencement of gastrostomy feeding References Broyer M, Le BC, Charbit M, Guest G, Tete MJ, Gangnadoux, MF, Niaudet P (2004) Long-term social outcome of children after kidney transplantation. Transplantation 77: Ingulli, EG. And Mak, RH. (2014). Growth in children with chronic kidney disease: role of nutrition. Growth hormone, dialysis, and steroids. Current Opinion Pediatrics, vol. 26, pp Rocha, I., Fonseca, N., Silva, LS., Martins, L., Dias, AC., Henriques, S., Faria, T., Costa, L., Rocha, A., Cabrita. And C, Mota. (2011). Impact of Pediatric Kidney Transplantation on long-term Professional and Social Outcomes. Transplantation Proceedings, 43, pp Seikaly, MG., Salhab, N., Warady, BA. And Stablein, D. (2007). 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