Evaluation of status of puberty in children and adolescents with end-stage renal disease undergoing maintenance hemodialysis

Abstract

Background and Objectives: The testosterone and estradiol sex hormones are susceptible to significant pathophysiological alterations in children with chronic renal failure under regular hemodialysis, leading to delayed pubertal maturation. This study aims to evaluate the plasma levels of testosterone and estradiol hormones in children and adolescents with end-stage renal disease (ESRD) under regular hemodialysis. Materials and Methods: This study was carried out on 40 children with ESRD under regular hemodialysis (20 males and 20 females) who were attending the Pediatric Department of Tanta University Hospital. Forty children, age- and sex-matched, were chosen and served as controls. All patients and controls were subjected to full history taking, thorough clinical examination including weight, height, body mass index (BMI), mid-arm circumference (MAC), arterial blood pressure, pubertal assessment according to Tanner's classification, routine laboratory investigation including complete blood count, blood urea, blood urea nitrogen, serum creatinine, serum albumin, serum electrolytes (ionized calcium, potassium, and phosphorus), serum total testosterone levels in boys, and serum estradiol levels in girls. Results: The mean values of weight, height, BMI, and MAC of patients' group was significantly lower than that of control group. The total male serum testosterone level in the male patients' group and the serum estradiol level in the female patients' group was significantly lower than that in control group. There were significant positive correlations between the age development and Tanner's stage development, male total serum testosterone level and female serum estradiol levels in both patients and control groups. Conclusions: The pubertal development of children and adolescents with ESRD is usually delayed as proven by decreased serum male total testosterone and female Estradiol hormones levels which suggest a state of hypogonadism. Nutritional therapy especially optimizing protein intake to prevent hypoproteinemia, adequate dialysis and correction of anemia are clinical trials.