Pubertal luteinizing hormone levels in children with chronic kidney disease and association with change in glomerular filtration rate

• Published in: Pediatric nephrology (Berlin, West) Vol. 39; no. 5; pp. 1543 - 1549
• Main Authors: Kim, Hannah S., Ng, Derek K., Matheson, Matthew B., Atkinson, Meredith A., Akhtar, Yasmin, Warady, Bradley A., Furth, Susan L., Ruebner, Rebecca L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2024; Springer Nature B.V
• Subjects: Child; Children; Childrens health; Chronic illnesses; Female; Glomerular Filtration Rate; Humans; Kidney diseases; Kidney Function Tests; Kidney Glomerulus; Luteinizing Hormone; Male; Medicine; Medicine & Public Health; Nephrology; Original Article; Pediatrics; Proteinuria; Puberty; Renal Insufficiency, Chronic - diagnosis; Urology; What’s New in Chronic Kidney Disease; Luteinizing hormone; CKD; GFR
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-023-06210-7

Background
Children with chronic kidney disease (CKD) are at risk for abnormalities in pubertal development. We aimed to describe the timing of pubertal onset by luteinizing hormone (LH) levels and the association between hormonal onset of puberty with changes in GFR.
Methods
Data from the Chronic Kidney Disease in Children (CKiD) study were collected prospectively. GFR was estimated at annual visits and measured by iohexol clearance every other year. LH was measured from stored repository serum samples in a nested sample of 124 participants. Hormonal onset of puberty was defined as LH level greater than or equal to 0.3 IU/L. A mixed effects model with random intercepts and slopes was used to compare the slope of decline of GFR before and after hormonal onset of puberty. The model was adjusted for age, glomerular disease diagnosis, baseline proteinuria on the log scale, and BMI.
Results
Median age at hormonal onset of puberty was 9.9 years (IQR 8.1, 11.9) in girls and 10.2 years (IQR 9.2, 11.0) in boys. The mixed effects model showed faster decline in both estimated GFR and measured GFR in boys after hormonal onset of puberty (
p
 < 0.001), and a similar but attenuated accelerated estimated GFR decline was observed for girls with no difference for measured GFR.
Conclusions
LH levels in the post-pubertal range were observed prior to clinical manifestations of puberty in children with CKD. Hormonal onset of puberty was associated with faster decline in GFR, particularly among boys with CKD.
Graphical abstract
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Supplementary information