Left ventricular hypertrophy in children and adolescents before and after kidney transplantation.

BACKGROUND: Left ventricular hypertrophy (LVH) is associated with a premature death in children with chronic kidney disease (CKD). We studied its change over time, related to a successful kidney transplantation (KTx) and assessed whether clinical variables were associated with the left ventricular mass index (LVMI). METHODS: We obtained the records of all children and adolescents, who were followed-up at the tertiary nephrology centre for children at the Children's University Hospital in Kosice, Slovakia, during 2008-2014, had completed echocardiographic studies while on chronic dialysis and had undergone a successful KTx, n=25. We assessed the longitudinally recorded left ventricular mass index (LVMI) and the presence/absence of LVH, and risk factors for LVH. RESULTS: The average prevalence of LVH was 23.5 % while on dialysis, and 29.4 % after KTx (p=0.06). Pre-post changes per patient were relatively big. Uncontrolled systolic hypertension was significantly related to LVMI (p=0.03). CONCLUSION: LVH is common after paediatric KTx and the reversibility of already present LVH seems to be rather problematic. Significant changes of LVMI on the individual level suggest that modification is feasible with a thorough control of (systolic) hypertension and of the other risk factors (Tab. 3, Fig. 1, Ref. 50).

Growth Patterns After Kidney Transplantation in European Children Over the Past 25 Years: An ESPN/ERA-EDTA Registry Study.

BACKGROUND: Improved management of growth impairment might have resulted in less growth retardation after pediatric kidney transplantation (KT) over time. We aimed to analyze recent longitudinal growth data after KT in comparison to previous eras, its determinants, and the association with transplant outcome in a large cohort of transplanted children using data from the European Society for Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry. METHODS: A total of 3492 patients transplanted before 18 years from 1990 to 2012 were included. Height SD scores (SDS) were calculated using recent national or European growth charts. We used generalized equation models to estimate the prevalence of growth deficit and linear mixed models to calculate adjusted mean height SDS. RESULTS: Mean adjusted height post-KT was -1.77 SDS. Height SDS was within normal range in 55%, whereas 28% showed moderate, and 17% severe growth deficit. Girls were significantly shorter than boys, but catch-up growth by 5 years post-KT was observed in both boys and girls. Children <6 years were shortest at KT and showed the greatest increase in height, whereas there was no catch-up growth in children transplanted >12. CONCLUSIONS: Catch-up growth post-KT remains limited, height SDS did not improve over time, resulting in short stature in nearly half of transplanted children in Europe.

Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study.

BACKGROUND: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment. METHODS: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias. RESULTS: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings. CONCLUSIONS: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.

Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population.

BACKGROUND: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population (p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis (p = 0.965, variance of the model-adjusted R² 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma.

Kidney diseases in Roma and non-Roma children from eastern Slovakia: are Roma children more at risk?

OBJECTIVES: To compare the occurence of primary renal diseases (PRD) in Roma and non-Roma children. METHODS: Data on all outpatients (n = 921) from a tertiary pediatric nephrology centre (<19 years) in eastern Slovakia were collected. We assessed early signs and symptoms and PRD for Roma and non-Roma children. RESULTS: The proportion of Roma among patients was relatively small regarding early signs like proteinuria but large regarding PRD with gross clinically apparent symptoms (e.g. Alport syndrome, p < 0.01 and systemic lupus erythematosus, p < 0.05). CONCLUSIONS: The overall proportion of Roma children in outpatients with kidney problems is smaller than the estimated proportion of Roma in all children in Slovakia, in particular for early signs, but not for major renal diseases.

Solitary functioning kidney in children--a follow-up study.

BACKGROUND/AIMS: This study aims to assess the cumulative incidence of elevated albuminuria, hypertension and decreased estimated glomerular filtration rate (eGFR) to identify possible renal injury in children with SFK. METHODS: Forty-two children with SFK (23 boys; 27 congenital) were included in a prospective follow-up study. Blood pressure, albuminuria and eGFR were assessed repeatedly and the cumulative incidence rate of various forms of renal injury, overall and by type of etiology, were evaluated. Finally, renal injury-free survival was analyzed. RESULTS: Mean follow-up was until age 11.3 years (SD 6.3 years). During follow-up, 16 (38.1%) patients met the criteria for renal injury, defined as hypertension (10; 23.8%), severely increased albuminuria (3; 7.1%) and a significantly impaired eGFR (<60 ml/min/1.73 m2) (5; 11.9%) and/or use of antihypertensive or antiproteinuric medication (11; 26.2%). Children with CAKUT in SFK had a significantly higher incidence of renal injury. The median time to develop renal injury was 12.8 years. CONCLUSION: A substantial proportion of children with SFK develop renal injury during childhood, especially those with CAKUT in the SFK. Therefore, close follow-up of albuminuria, blood pressure and eGFR are warranted to identify chronic kidney disease in its early stages.

End-stage renal disease among Roma and non-Roma: Roma are at risk.

OBJECTIVES: Ethnic differences in the occurrence of end-stage renal disease (ESRD) are reported on various populations across the world, but evidence on Roma is lacking. The aim of this study was to explore the relative risk (RR) of ESRD for Roma who constitute a major minority in Slovakia. METHODS: Patients treated by means of hemodialysis during 2005-2008 were questioned for their ethnicity. Rates of ESRD among Roma and non-Roma based on hemodialysis data were calculated as well as the RR of Roma for ESRD. The latter was repeated after standardization for differences in age of both populations. RESULTS: Roma represented 11.6 % of all hemodialyzed patients. The RR of ESRD for Roma was 1.34, compared to the majority population. After age standardization, the RR for Roma was 2.85. CONCLUSION: This study shows that the risk for ESRD is significantly higher for Roma than for non-Roma. A genetic propensity of Roma to renal failure may partially explain the higher risk. Moreover, a poorer control of risk factors for ESRD in Slovak Roma contributes to the increased risk.

End-stage renal disease in Slovak children: epidemiology from a European perspective.

The aim of this study was to examine the occurrence of end-stage renal disease (ESRD) in Slovak children, to compare it with earlier Slovak data and with data from other European countries, and to explore etiology. Over the years 2003-2009, data on the incidence and prevalence of all cases of ESRD in children from all four Slovak tertiary pediatric centers were collected. The data were compared with two earlier Slovak studies and with European data from the European Society of Paediatric Nephrology. The median annual incidence rate of ESRD in Slovak children under 15 years of age was 6.6 per million age-related population (pmarp). The prevalence rate on 31 December 2009 was 24.1 pmarp. Compared with the last study (18.6 pmarp), the differences were not statistically significant. The comparison with neighboring countries and with the European average shows no significant difference in incidence, while prevalence is significantly lower compared to neighboring Austria and some other (mostly western) European countries as well as the European average. In conclusion, during the past decade, the incidence and prevalence rates of ESRD in Slovak children have remained stable. Compared to the European average, the prevalence in Slovak children is significantly lower.