Serum uric acid concentration is associated with lower glomerular filtration rate in children undergoing kidney transplantation.

BACKGROUND: The relationship between serum concentration of uric acid (UA) and chronic kidney disease is complex due to many confounding variables. There is currently debate over whether hyperuricemia acts as a marker of kidney disease or as an independent risk factor. OBJECTIVES: To test the impact of serum UA concentration on the estimated glomerular filtration rate (GFR) of children undergoing kidney transplantation. PATIENTS AND METHODS: Prospective longitudinal study of children and adolescents after kidney transplantation. We analyzed clinical, anthropometric, and laboratory data at pre-transplant and 1, 3, and 6 months after transplant. We developed models of repeated measures analysis, using the generalized estimating equations technique for the outcome evolution of the estimated GFR at 1, 3 and 6 months. High serum UA concentration at 1 and 3 months was modeled as the main exposure variable. RESULTS: We included 103 transplant patients. In a model adjusted for time, recipient sex and age, the occurrence of acute rejection episodes, and the estimated glomerular filtration at baseline, the trajectory of GFR exhibited an inverse relationship with UA (ß = -7.1, 95% CI: -11.5 to -2.6, p < .01). CONCLUSION: Serum UA increase was associated with lower graft function over time.

Time from kidney failure onset to transplantation and its impact on growth in pediatric patients.

BACKGROUND: In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height. METHODS: Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height. RESULTS: A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05-1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49-0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53-0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53-0.75; p < .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001). CONCLUSION: Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.

Prevalence, risk factors, and consequences of overweight in children and adolescents who underwent renal transplantation--short- and medium-term analysis.

UNLABELLED: To determine the prevalence and risk factors for (i) overweight/obesity and (ii) weight gain six months after transplantation and to study the effect of weight excess on graft function and survival. We performed a retrospective study of kidney transplanted children. ENDPOINTS: (i) prevalence of overweight/obesity at sixth month, (ii) gaining 1.0 BMI SDS from one to six months. To study the effects of weight excess, graft function and survival at 36 months were the endpoints. The study included 197 individuals. At sixth month, 57/197 (29%) presented overweight/obesity, and the factors associated to this outcome were: (i) age at transplantation (OR = 3.04) and (ii) overweight/obesity in the first month (OR = 22.16). Groups presented no difference on graft function and survival at 36 months. From one to six months, 90/197 (46%) patients gained >1.0 BMI SDS. This outcome was associated with (i) female sex (OR = 2.50), (ii) steroids' pulses (OR = 2.98), (iii) steroids exposure (OR = 1.04), and (iv) living donor (OR = 2.69). The group that gained BMI presented a lower 36 months graft survival (86% vs. 98%, p < 0.001). Weight excess and gain after transplantation are frequent, particularly in younger female recipients and in those receiving high steroids exposure. The lower graft survival in patients with rapid weight gain deserves investigation.

Fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal / Cardiovascular risk factors in pediatric patients after one year of renal transplant / Factores de riesgo cardiovascular en pacientes pediátricos después de un año de trasplante renal

Objetivo: Identificar a frequência de diabetes mellitus e a presença de fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal. Métodos: Estudo retrospectivo, de cunho documental e exploratório, realizado de janeiro de 2000 a janeiro de 2006, abrangendo 111 prontuários de pacientes pediátricos (0 a 18 anos incompletos) submetidos a transplante renal no Hospital do Rim e Hipertensão e no Hospital São Paulo da Universidade Federal de São Paulo. Resultados: Foram analisados 111 pacientes, 50,5 por cento utilizavam anti-hipertensivos antes do transplante renal. Um ano após este número caiu para 28 por cento. No pré-transplante 13,5 por cento pacientes apresentaram sobrepeso e após um ano não houve alteração importante (12,6 por cento). O número de pacientes obesos aumentou 50 por cento após um ano de transplante renal. Aproximadamente 1 por cento das crianças desenvolveram diabetes mellitus pós-tranplante renal. Conclusão: A presença de excesso de peso (sobrepeso e obesidade), hipertensão arterial e diabetes mellitus são freqüentes em pacientes pediátricos pós-tranplante renal.

Objective: To identify the prevalence of diabetes mellitus and the presence of cardiovascular risk factors in pediatric patients after one year of renal transplant. Methods: This was an exploratory retrospective study. Data were collected from 111 medical records of pediatric patients (aged 0 to incomplete 18 year old) who underwent renal transplant at both the "Hospital do Rim and Hypertension (Renal and High Blood Pressure Hospital) and the São Paulo Hospital of the Federal University of São Paulo between January 2000 and January 2006. RESULTS: A half of patients (50.5 percent) used high blood pressure medications prior to undergoing renal transplant. A year after renal transplant the use of high blood pressure medications by the pediatric patients was reduced by 28 percent. Before transplant, 13.5 percent of the patients were overweighed and did not have any significant changes in their weight after the transplant (12.6 percent). There was an increase in the number of overweight patients after a year of renal transplant by 50.0 percent. Approximately 1.0 percent of the patients developed diabetes mellitus after the renal transplant. Conclusion: Obesity, high blood pressure, and diabetes mellitus were common conditions among pediatric patients after renal transplant.

Objetivo: Identificar la frecuencia de diabetes mellitus y la presencia de factores de riesgo cardiovascular en pacientes pediátricos después de un año de trasplante renal. Métodos: Estudio retrospectivo, de orden documental y exploratorio, realizado de enero de 2000 a enero de 2006, abarcando 111 fichas de pacientes pediátricos (0 a 18 años incompletos) sometidos a trasplante renal en el Hospital del Riñón e Hipertensión y en el Hospital Sao Paulo de la Universidad Federal de Sao Paulo. Resultados: Fueron analizados 111 pacientes, 50,5 por ciento utilizaban anti-hipertensores antes del trasplante renal. Un año después este número cayó para 28 por ciento. En el pre-trasplante, 13,5 por ciento pacientes presentaron sobrepeso y después de un año no hubo alteración importante (12,6 por ciento). El número de pacientes obesos aumentó 50 por ciento después de un año de trasplante renal. Aproximadamente 1 por ciento de los niños desarrollaron diabetes mellitus después del trasplante renal. Conclusión: La presencia de exceso de peso (sobrepeso y obesidad), hipertensión arterial y diabetes mellitus son frecuentes en pacientes pediátricos después del trasplante renal.