G352(P) Reach for the sky: identifying and managing growth failure in children with chronic renal insufficiency

Background Growth retardation is well documented in children with chronic kidney disease (CKD). Figures from the UK Renal Registry indicate that 29% of children who undergo renal transplantation and 41% of children on dialysis are below the 2nd percentile for height. Short stature is associated with increased morbidity and mortality. NICE guidance recommends growth hormone as a treatment option for children with growth failure associated with chronic renal insufficiency (CRI). Aims To increase recognition of growth failure in children with CRI by ensuring regular plotting of height in all patients on renal replacement therapy (RRT) and >80% of those with CKD stage 3–5. All eligible children with CRI and growth failure should be offered growth hormone. Methods Data was collected in 2018 from patients on RRT or who had underwent renal transplant within the previous 5 years. Results were presented at the renal MDT meeting to improve awareness and highlight where improvements could be made. In line with BSPED and BAPN endorsed guidelines, practical changes were introduced and audited using Plan-Do-Study-Act cycles. These included ensuring patients’ current notes have an up-to-date growth chart, and the introduction of a mid parental height and growth velocity monitoring proforma. A hospital guideline was designed which included a standardised referral letter to endocrinology for patients who should be considered for growth hormone. Results The 2018 audit showed that 60% of the 15 patients on RRT or who had undergone recent renal transplantation demonstrated growth failure. Despite this, only two patients had been referred for growth hormone treatment. On re-audit, all children currently on RRT were assessed for growth hormone and referred to Endocrinology as appropriate. Regular growth monitoring improved from 60% to >80% also. The new proforma continues to highlight patients with CKD stage 3–5 meeting criteria for growth hormone and referral to endocrinology is improving as a result. Conclusion With heightened awareness in the renal team, and a renewed focus on regular growth monitoring, children with CRI and growth failure, are being more promptly recognised and offered growth hormone in line with NICE guidance.