Background Recent registry reports related short stature at the time of dialysis initiation to increased morbidity and mortality. Growth may therefore be regarded as an overall indicator of severity of disease and quality of therapy in pediatric chronic renal insufficiency.

Methods In this retrospective study, we assessed diagnostic and therapeutic variables at referral and at dialysis initiation in 47 children (24 boys, aged 7.1 yrs) with congenital renal diseases who had been followed for 2.5 yrs, presenting with a residual renal function of 25 ml/min/1.73m2. These variables were compared to body stature and interval growth during pre-dialysis care.

Results At referral, 36% of children had severe growth failure with SDS height <2. Stature at that time point predicted stature at dialysis initiation (rho=0.81, p<0.001), and showed significant correlations with residual renal function (rho=0.37, p=0.026). Catch up-growth during pre-dialysis care was achieved in 37% of the children. Only hemoglobin (OR=2.0, p=0.019) and erythropoetin therapy (OR=12.4, p=0.032) at first referral were significant and independent predictors. Children on erythropoietin therapy were also significantly more likely to receive other treatments.

Conclusion Taken together, our study suggests that the most relevant factors for stature and growth during pre-dialysis care were already determined at the time of referral. Interestingly, this was not only true for severity-of-disease parameters such as residual renal function and hemoglobin, but also for therapeutic interventions. More aggressive and earlier initiation of therapy is needed to prevent growth failure.