Impairment of pubertal growth and sexual maturation resulting in reduced adult height is a significant complication in children suffering from CKD [10].
Nevertheless, the published literature is scarce regarding the growth and pubertal status in children with CKD or ESRD. Therefore, we conducted the present cross-sectional study in order to clinically evaluate the development and pubertal status in Egyptian children with CKD and ESRD.
Regarding demographic characteristics of the included patients, the mean age of CKD and ESRD patients was 12.74 ± 1.06 and 12.85 ± 1.23 years old, respectively. The majority of patients in both groups were males. This male predominance can be attributed to congenital renal diseases being more common in males [11].
Similar to our findings, Clavé et al. [12] studied adolescent patients in French pediatric hemodialysis centers and found that their mean age was 13.9 ± 2.0 years, and the majority of them were males.
In our study, the most common causes of CKD were genetic causes, including neurogenic bladder and hypoplastic and solitary kidney, while other reasons included nephrotic syndrome and glomerulonephritis.
Similar to our findings, Ardissino et al. [13] aimed to assess the epidemiology of childhood CKD and found that the leading causes of CKD were hypodysplasia associated with urinary tract malformations (53.6%) and isolated hypodysplasia (13.9%). In contrast, glomerular diseases accounted for as few as 6.8%.
Contrary to our findings, Hazza [14] reviewed the records of 1018 (56.7% were males, ages ranging from 1 to 19 years) Egyptian patients suffering from CKD and ESRD followed up at the pediatric nephrology units (outpatient clinics and dialysis units) of 11 universities over a period of 2 years. The most common cause of CKD was obstructive uropathy (21.7%), followed by primary glomerulonephritis (15.3%), reflux/urinary tract infection (14.6%), aplasia/hypoplasia (9.8%), and familial/metabolic diseases (6.8%).
In the present study, we found that the mean weight, height, and BMI were significantly lower in patients with CKD and ESRD than in normal children. Most cases of ESRD (70.0%) and about half of the instances of CKD (45.2%) have their weight below the 3rd percentile compared to and control group (3.3%). Similarly, most cases of ESRD (80.0%) and 59.5% of CKD have their height below the 3rd percentile compared to control group (8.2%). A total of 9.5% of CKD patients and 10% of ESRD have their BMI below the 3rd percentile compared to the control group of 0.0%.
In agreement with our findings, Sozeri et al. [15] reported that the mean weight and height standard deviation score (SDS) was lower in CKD and ESRD patients than in healthy controls.
Additionally, Abd El-Monem [16] found that compared with normal children, children with CKD showed a statistically significant short stature, low body weight, anemia, and poor QOL.
Gupta [17] aimed to assess nutritional intake and anthropometry of children presenting with CKD in a developing country. Out of 45 children, 27 (60%) had moderate to severe malnutrition at assessment. The mean weight and height (SDS) were −2.77 ± 2.07 and −2.30 ± 1.38, respectively.
In the present study, we found a statistically significant difference between patients and control groups regarding the breast and testicular stage, pubic hair stage, and axillary hair stage. Cases with CKD and ESRD had significantly lower stages than healthy controls. Most cases of ESRD were either stages 1 or 2. The CKD cases were also stages 1 and 2 with a higher level in stage 2. Thus, pubertal growth was substantially more impaired in dialysis patients than in CKD patients.
In concordance with our findings, El-Gamasy et al. [18] evaluated the development of Egyptian children and adolescents with ESRD under regular hemodialysis. The mean Tanner stages were significantly lower in ESRD patients than in a control group.
Our study found that patients with CKD and ESRD had a significantly older age at menarche than the control group.
Similarly, Ferris [19] reported that approximately half of the children with CKD had delayed puberty and late age at menarche.
Similar to our findings, Noh and Koo [20] investigated the association between the age of menarche and CKD and found that the age of menarche in the CKD group was 16.2 ± 9 years old, which was higher than that in the non-CKD group (P < 0.001).
We acknowledge that the present study has several limitations. The sample size of our cohort was relatively small, which may affect the generalizability of our findings. In addition, the study was based only on a single-center experience. Also, the significant differences in age and sex between the groups are considered important factors affecting puberty. Moreover, long-term patient-centered outcomes were not utilized in our research.
