Children with CKD are at increased risk for delays in normal growth and pubertal development.1–4 Puberty is typically assessed by clinical evaluation of Tanner stage, with pubertal onset defined as transition from stage 1 to stage 2 (thelarche in girls and testicular enlargement in boys). Puberty can also be defined by peak growth velocity and (in girls) menarche. In the general population, puberty usually begins between ages 8 and 13 (girls) and 9 and 14 (boys).5 There are limited studies on the timing of puberty among children with CKD.