A clinical predictive model of chronic kidney disease in children with posterior urethral valves
Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs.
In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables.
Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome.
The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.
KeywordsPosterior urethral valves Fetal hydronephrosis Vesicoureteral reflux Urinary tract infection Hypertension Proteinuria Chronic kidney disease
R.H.M. is supported by NIH grants U01 DK-03012 and R24HD050837. E.A.O. is supported by CAPES grant 2746-15-8. This study was partially supported by CNPq (Brazilian National Research Council, Grant 481649/2013-1, Grant 460334/2014-0), FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Grant PPM-00228-15, Grant PPM-00555-15), and the INCT-MM Grant (FAPEMIG: CBBAPQ-00075-09/CNPq 573646/2008-2).
Compliance with ethical standards
The study was approved by the Ethics Committee of UFMG.
Conflicts of interest
The authors declare that they have no conflict of interest.
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