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Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Renal Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom

Correspondence: Dr. Lesley Rees, Renal Office, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK. Phone: 0207-405-9200, ext. 6725; Fax: 0207-829-8841; E-mail: l.rees{at}ich.ucl.ac.uk

Background and objectives: In 2000, we reported the outcome of 101 children with a GFR <20 ml/min per 1.73 m² at 0.3 yr of age (range 0.0 to 1.5 yr). Long-term data on such young children are scarce.

Design, setting, participants, & measurements: Mortality, treatment modalities, and growth were reanalyzed 9.9 yr later.

Results: Of the 101 patients, 28 died and three were lost to follow-up during 13.90 yr (range 0.03 to 22.90 yr). One-, 2-, 5-, 10-, 15-, 20-, and 22-yr survivals were 87, 81, 77, 75, 73, 72, and 64%, respectively. Fifty-one children had comorbidities. Sixty-six percent were tube fed for 1.7 yr (range 0.1 to 6.9 yr), 37% had a gastrostomy, and 13% had a Nissen fundoplication. Mean height SD score (SD) was –0.42 (2.33) at birth (n = 40), –2.07 (1.34) at 0.5 (n = 62), –1.93 (1.38) at 1 (n = 72), –1.14 (1.14) at 5 (n = 67), –1.04 (1.15) at 10 (n = 62), –1.84 (1.32) at 15 (n = 40), and –1.68 (1.52) at age 18 yr (n = 32). Comorbidities adversely influenced growth (P < 0.01) and final height (P = 0.02): Mean height SD score (SD) was –1.16 (1.38) in otherwise normal adults.

Conclusions: Growth and final height in infants with severe chronic kidney disease are influenced by comorbidity. Intensive feeding and early transplantation resulted in a mean adult height within the normal range in patients without comorbidities. Overall mortality is comparable to that of older children.

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