The effects of chronic renal failure in infancy on growth, nutritional status and body composition

Abstract

Growth, body composition, and nutritional status were assessed in 21 children (age range, 0.3-11.9 years) with advanced chronic renal failure (CRF, glomerular filtration rate <20 ml/min/1.73m2), which had presented in the first year of life. Height standard deviation score was —2 or less in 16 children. Intracellular water (ICW), an index of body cell mass, was reduced compared to values predicted for height in 14 children studied under 3 years of age [Group I, mean ICW observed:predicted ratio (O/P) 0.67, range 0.50-0.93], but was normal in seven prepubertal children studied between 5-11.9 years of age (Group II, mean ICW O/P 1.01, range 0.88-1.23, P < 0.01 compared to Group I). Both ICW O/P and weight for height index increased significantly with age throughout childhood (r = 0.79, P < 0.001 and r = 0.62, P < 0.05, respectively). In Group I, height standard deviation score correlated significantly with ICW O/P, weight for height index, and serum transferrin. The most growth retarded children had the most marked reduction in body cell mass, were the most wasted, and had the lowest serum transferrin levels. In this group mean serum transferrin was significantly reduced compared to normal, and levels were closely correlated with weight for height index. Repeat estimations of ICW, performed in seven Group I children after an interval of 0.4-0.8 years, showed an increase towards predicted normal in six cases. In Group II, mean weight for height index was normal (101%, range 90-114%) and significantly greater than for Group I (mean 86%, range 70-114%, P < 0.01), and there was no significant correlation between height standard deviation score and either ICW O/P ratio, weight for height index, or serum transferrin. Thus, abnormalities of body composition and nutritional status could no longer be implicated as important determi¬nants of height deficit. Dietary calorie intakes in all children not receiving calorie supplements, and in many of those receiving supplements, were below recommended intakes for height age in both groups. Speculation: These results indicate similarities between children with early onset chronic renal failure and those with protein-calorie malnutrition, and suggest the importance of nutritional deficiency and consequent body protein depletion in the early pathogenesis of their growth retardation. The increase in intracellular water values towards normal during infancy, and the finding of normal intracellular water and weight for height in older children, suggest that adaptive mechanisms may have minimised long term disturbances of body composition. Nutritional therapy to promote catch-up growth may only succeed if applied early in childhood before this adaptation has occurred. © 1982 International Pediatric Research Foundation, Inc.