Factors Associated with Statural Growth in Pediatric Kidney Transplant Recipients with Focus on Metabolic Acidosis

Overview

Journal Pediatr Nephrol

Date 2025 Jan 26

PMID 39865159

Authors

Agnieszka Prytula

Dries Reynders

Els Goetghebeur

Kai Krupka

Justine Bacchetta

Nele Kanzelmeyer

Isabella Guzzo

Raffaella Labbadia

Elisa Benetti

Mohan Shenoy

Anne-Laure Sellier-Leclerc

Jun Oh

Mieczyslaw Litwin

Jacek Rubik

Atif Awan

Ilmay Bilge

Lutz T Weber

Dominik Muller

Thomas Simon

Lars Pape

Burkhard Tonshoff

Affiliations

Soon will be listed here.

Abstract

Background: We investigated factors associated with post-transplant growth in pediatric kidney transplant (KTx) recipients with a focus on plasma bicarbonate (HCO3) and estimated the effect of alkali treatment on growth.

Methods: In this study of the CERTAIN Registry, data were collected up to 5 years post-transplant. Generalized Additive Mixed Models were applied to assess the association between post-transplant growth and covariates. A trial-emulation analysis was performed to estimate the causal effect of alkali supplementation on growth.

Results: We report on 2147 primary KTx recipients with a median age at KTx of 10.2 (IQR 5.1;14.3) years. No statistically significant association was found between growth and HCO3 (p = 0.21), but the shape of the estimated conditional association showed a decreasing estimated growth with increasing HCO3. Glucocorticoid treatment and allograft rejection showed an inverse association with growth. Living donor KTx, glomerulopathy, recombinant growth hormone use, low height z-score at KTx, younger age, and higher eGFR were positively associated with growth. The trial-emulation analysis included patients at 30 days and 3, 6, and 9 months post-transplant with HCO3 < 22 mmol/L and no prior alkaline treatment. Alkaline treatment was initiated in 194, 93, 47, and 25 patients, respectively. After adjustment for confounders, there was no significant difference in growth at 1-year post-transplant in treated and untreated patients.

Conclusions: We found no association between HCO3 and growth nor evidence of improved growth after treatment of metabolic acidosis. Living donor KTx was positively associated with post-transplant growth, while there was an inverse association with allograft rejection.

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