Growth Failure Associated With Parathyroid Hormone Levels in Pediatric Dialysis Patients: A Nationwide Cohort Study.

RATIONALE &

OBJECTIVE

Growth failure is prevalent in pediatric dialysis patients. Physical growth is limited to a specific period, and missed interventions may cause lifelong growth retardation. We aimed to investigate the association of secondary hyperparathyroidism with short stature and height growth failure.

STUDY

DESIGN

Cohort study.

SETTING &

PARTICIPANTS

Patients aged 1-20 years who initiated dialysis and were registered in the nationwide dialysis registry of Japan between 2009 and 2020.

EXPOSURE: Intact parathyroid hormone (PTH) levels.

OUTCOMES: Height standard deviation score (SDS), short stature (less than or equal to -2.0 SDS of height), height velocity SDS, and height growth failure (less than or equal to -1.5 SDS of height velocity).

ANALYTICAL APPROACH: We examined the association between intact PTH levels and the outcomes in both cross-sectional and longitudinal analyses.

RESULTS

Intact PTH, height, and weight were measured in 622 patients. The median dialysis vintage was 10 months, the mean age was 13 years, 59% were boys, 50% were receiving peritoneal dialysis, and the median value of intact PTH was 183 pg/mL. At enrollment, the median height SDS was -1.9 (IQR, -3.3 to -0.6), and 302 patients (49%) had a short stature. The median SDS of height velocity during the first year was -2.4 (IQR, -5.6 to -1.5), and 205 patients (75%) had height growth failure (a decrease in height velocity). Elevated intact PTH levels per doubling were associated with a significant decrease in height velocity (β = -0.26; 95% CI, -0.49 to -0.02) and height growth failure (OR, 1.16; 95% CI, 1.00-1.34). Restricted cubic spline analysis showed a decrease in height velocity with increasing intact PTH levels.

LIMITATIONS: Lacked data on recombinant human growth hormone use and limited follow-up periods to evaluate the impact of PTH on long-term growth.

CONCLUSIONS

Our findings suggest the involvement of secondary hyperparathyroidism in height growth failure in pediatric dialysis patients.