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Estimating Time to ESRD in Children With CKD.
Am J Kidney Dis. 2018 06; 71(6):783-792.AJ

Abstract

RATIONALE & OBJECTIVE

The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients' risk for CKD progression. Few data for children informed guideline development.

STUDY DESIGN

Observational cohort study.

SETTINGS & PARTICIPANTS

Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial.

PREDICTOR

Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry.

OUTCOME

A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR<15mL/min/1.73m2. eGFR was estimated using the CKiD-derived "bedside" equation.

ANALYTICAL APPROACH

Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk.

RESULTS

Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73m2, 60% were males, and 13% had UPCRs>2.0mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29mL/min/1.73m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90mL/min/1.73m2 and UPCRs<0.5mg/mg to 0.8 years for eGFRs of 15 to 30mL/min/1.73m2 and UPCRs>2mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models.

LIMITATIONS

Observational study, used cross-validation rather than external validation.

CONCLUSIONS

CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.

Authors+Show Affiliations

Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: furths@email.chop.edu.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Department of Pediatrics, Queen Elizabeth Hospital, Hong Kong.Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.Division of Pediatric Nephrology, University of New Mexico Children's Hospital, Albuquerque, NM.Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, Heidelberg, Germany.Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, Heidelberg, Germany.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

29653769

Citation

Furth, Susan L., et al. "Estimating Time to ESRD in Children With CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 71, no. 6, 2018, pp. 783-792.
Furth SL, Pierce C, Hui WF, et al. Estimating Time to ESRD in Children With CKD. Am J Kidney Dis. 2018;71(6):783-792.
Furth, S. L., Pierce, C., Hui, W. F., White, C. A., Wong, C. S., Schaefer, F., Wühl, E., Abraham, A. G., & Warady, B. A. (2018). Estimating Time to ESRD in Children With CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 71(6), 783-792. https://doi.org/10.1053/j.ajkd.2017.12.011
Furth SL, et al. Estimating Time to ESRD in Children With CKD. Am J Kidney Dis. 2018;71(6):783-792. PubMed PMID: 29653769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimating Time to ESRD in Children With CKD. AU - Furth,Susan L, AU - Pierce,Chris, AU - Hui,Wun Fung, AU - White,Colin A, AU - Wong,Craig S, AU - Schaefer,Franz, AU - Wühl,Elke, AU - Abraham,Alison G, AU - Warady,Bradley A, AU - ,, AU - ,, Y1 - 2018/04/10/ PY - 2017/07/27/received PY - 2017/12/19/accepted PY - 2018/4/15/pubmed PY - 2019/8/14/medline PY - 2018/4/15/entrez KW - Pediatric KW - children KW - chronic kidney disease (CKD) KW - disease progression KW - disease staging KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - proteinuria KW - risk pattern KW - urinary protein-creatinine ratio (UPCR) SP - 783 EP - 792 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 71 IS - 6 N2 - RATIONALE & OBJECTIVE: The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients' risk for CKD progression. Few data for children informed guideline development. STUDY DESIGN: Observational cohort study. SETTINGS & PARTICIPANTS: Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. PREDICTOR: Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. OUTCOME: A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR<15mL/min/1.73m2. eGFR was estimated using the CKiD-derived "bedside" equation. ANALYTICAL APPROACH: Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. RESULTS: Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73m2, 60% were males, and 13% had UPCRs>2.0mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29mL/min/1.73m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90mL/min/1.73m2 and UPCRs<0.5mg/mg to 0.8 years for eGFRs of 15 to 30mL/min/1.73m2 and UPCRs>2mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. LIMITATIONS: Observational study, used cross-validation rather than external validation. CONCLUSIONS: CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/29653769/Estimating_Time_to_ESRD_in_Children_With_CKD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(18)30101-X DB - PRIME DP - Unbound Medicine ER -