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Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study.
Am J Kidney Dis. 2018 05; 71(5):648-656.AJ

Abstract

BACKGROUND

Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD).

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS

We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study.

PREDICTORS

Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models.

OUTCOMES

Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models.

RESULTS

During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1).

LIMITATIONS

Observational nature of our study, lack of longitudinal assessments of inflammatory markers.

CONCLUSIONS

In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu.Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA.Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO.Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.Division of Pediatric Nephrology, Department of Pediatrics, Rady Children's Hospital, La Jolla, CA.Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29132947

Citation

Ku, Elaine, et al. "Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 71, no. 5, 2018, pp. 648-656.
Ku E, Kopple JD, McCulloch CE, et al. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis. 2018;71(5):648-656.
Ku, E., Kopple, J. D., McCulloch, C. E., Warady, B. A., Furth, S. L., Mak, R. H., Grimes, B. A., & Mitsnefes, M. (2018). Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 71(5), 648-656. https://doi.org/10.1053/j.ajkd.2017.08.013
Ku E, et al. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis. 2018;71(5):648-656. PubMed PMID: 29132947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. AU - Ku,Elaine, AU - Kopple,Joel D, AU - McCulloch,Charles E, AU - Warady,Bradley A, AU - Furth,Susan L, AU - Mak,Robert H, AU - Grimes,Barbara A, AU - Mitsnefes,Mark, Y1 - 2017/11/11/ PY - 2017/03/31/received PY - 2017/08/03/accepted PY - 2017/11/15/pubmed PY - 2019/8/16/medline PY - 2017/11/15/entrez KW - BMI trajectory KW - Body mass index (BMI) KW - CKD progression KW - adolescents KW - children KW - chronic kidney disease (CKD) KW - end-stage renal disease (ESRD) KW - growth KW - height KW - malnutrition KW - pediatric CKD KW - weight loss SP - 648 EP - 656 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 71 IS - 5 N2 - BACKGROUND: Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD). STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study. PREDICTORS: Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models. OUTCOMES: Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models. RESULTS: During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1). LIMITATIONS: Observational nature of our study, lack of longitudinal assessments of inflammatory markers. CONCLUSIONS: In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/29132947/Associations_Between_Weight_Loss_Kidney_Function_Decline_and_Risk_of_ESRD_in_the_Chronic_Kidney_Disease_in_Children__CKiD__Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(17)30944-7 DB - PRIME DP - Unbound Medicine ER -