Stunting in under-five children with chronic kidney disease: Indian synthetic growth charts are more accurate than World Health Organization growth standards

Avi Khanna; Rahul Jahagirdar; Ruma Deshpande; Vaman Khadilkar

doi:10.18203/2349-3291.ijcp20260819

Authors

Avi Khanna Department of Paediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, India
Rahul Jahagirdar Department of Pediatric Endocrinology, Bharati Hospital (Deemed to be University) and Medical College, Pune, Maharashtra, India
Ruma Deshpande Department of Pediatric Endocrinology, Bharati Hospital (Deemed to be University) and Medical College, Pune, Maharashtra, India
Vaman Khadilkar Department of Growth and Pediatric Endocrinology, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20260819

Keywords:

Chronic kidney disease, Growth assessment, Reference standards, Stunting, WHO growth standards

Abstract

Background: Accurate growth monitoring is critical in pediatric chronic kidney disease (CKD), where impaired linear growth is common. The WHO multicentre growth reference study (MGRS) 2006 standards are widely used but may overestimate stunting in Indian children due to ethnogenetic and environmental differences. Indian synthetic growth charts, developed using the LMS method and based on national data, may offer a more appropriate reference. This study compared stunting prevalence in under-five children with CKD using world health organization (WHO) standards and Indian synthetic growth charts.

Methods: This cross-sectional observational study was conducted at a tertiary care centre in Pune, Maharashtra, over 18 months (January 2023-June 2024). A total of 120 term-born children aged 0-60 months with confirmed CKD were enrolled. Standardized anthropometric measurements of length/height were obtained. Length/height-for-age Z-scores were calculated using WHO AnthroPlus software and LMS values for Indian synthetic charts. Stunting was defined as a Z-score<-2 SD. CKD severity was categorized as mild, moderate, or severe based on clinical, biochemical, and imaging criteria.

Results: Across all age groups, Z-scores were consistently higher when assessed using Indian synthetic charts compared to WHO standards. The prevalence of stunting was significantly lower using synthetic charts (boys 5.9%, girls 1.9%) than WHO charts (boys 13.4%, girls 5.7%). Synthetic charts demonstrated superior discrimination of growth impairment across CKD severity, with a larger Z-score difference between mild and severe CKD (0.597 SD vs. 0.440 SD with WHO).

Conclusions: Indian synthetic growth charts provide a more accurate, population-specific assessment of growth in children with CKD. Their use reduces overdiagnosis of stunting and improves identification of clinically meaningful growth deficits, supporting their integration into routine pediatric CKD monitoring in India.

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