Common clinical markers predict end-stage renal disease in children with obstructive uropathy
Obstructive uropathy (OU) is a common cause of end-stage renal disease (ESRD) in children. Children who escape the newborn period with mild-to-moderate chronic kidney disease (CKD) continue to be at increased risk. The predictive ability of clinically available markers throughout childhood is poorly defined.
Patients with OU were identified in the Chronic Kidney Disease in Children Study. The primary outcome of interest was renal replacement therapy (RRT) (cases). Controls were age matched and defined as patients within the OU cohort who did not require RRT during study follow-up.
In total, 27 cases and 41 age-matched controls were identified. Median age at baseline and age at outcome measurement were 10 vs. 16 years, respectively. First available glomerular filtration rate (GFR) (36.9 vs. 53.5 mL/min per 1.73 m2), urine protein/creatinine (Cr) (0.40 vs. 0.22 mg/mg) and microalbumin/Cr (0.58 vs. 0.03 mg/mg), and serum CO2 (20 vs. 22 mmol/L) and hemoglobin (12.4 vs. 13.2 g/dL) differed significantly between cases and controls, respectively. GFR declined 3.07 mL/min per 1.73 m2/year faster in cases compared to that in controls (p < 0.0001). Urine protein/Cr and microalbumin/Cr increased by 0.16 and 0.11 per year more in cases compared to those in controls, respectively (p ≤ 0.001 for both). Serum phosphate increased by 0.11 mg/dL and serum albumin and hemoglobin decreased by 0.04 (g/dL) and 0.14 (g/dL) per year more for cases compared to those for controls, respectively (p < 0.05 for all).
Age-specific baseline and longitudinal measures of readily available clinical measures predict progression to ESRD in children with mild-to-moderate CKD from OU.
KeywordsObstruction Uropathy Chronic kidney disease End-stage renal disease Prediction CKiD
Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, U01-DK-66116). The CKiD website is located at https://statepi.jhsph.edu/ckid.
Compliance with ethical standards
This study was assigned exempt status by the institutional review board due to the de-identification of data received from CKiD.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Weaver DJ, Jr., Somers MJG, Martz K, Mitsnefes MM (2017) Clinical outcomes and survival in pediatric patients initiating chronic dialysis: a report of the NAPRTCS registry. Pediatr Nephrol 32:2319–2330. doi: https://doi.org/10.1007/s00467-017-3759-4
- 7.Smith GH, Canning DA, Schulman SL, Snyder HM, 3rd, Duckett JW (1996) The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol 155:1730–1734Google Scholar
- 11.Bajpai M, Chaturvedi PK, Bal CS, Sharma MC, Kalaivani M (2013) Posterior urethral valves: persistent renin angiotensin system activation after valve ablation and role of pre-emptive therapy with angiotensin converting enzyme-inhibitors on renal recovery. J Indian Assoc Pediatr Surg 18:74–78. https://doi.org/10.4103/0971-9261.109357 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Sanna-Cherchi S, Ravani P, Corbani V, Parodi S, Haupt R, Piaggio G, Innocenti ML, Somenzi D, Trivelli A, Caridi G, Izzi C, Scolari F, Mattioli G, Allegri L, Ghiggeri GM (2009) Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int 76:528–533. https://doi.org/10.1038/ki.2009.220 CrossRefPubMedGoogle Scholar
- 14.Wuhl E, van Stralen KJ, Verrina E, Bjerre A, Wanner C, Heaf JG, Zurriaga O, Hoitsma A, Niaudet P, Palsson R, Ravani P, Jager KJ, Schaefer F (2013) Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract. Clin J Am Soc Nephrol 8:67–74. https://doi.org/10.2215/CJN.03310412 CrossRefPubMedGoogle Scholar
- 17.Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, Wong C, Munoz A, Warady BA (2006) Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clin J Am Soc Nephrol 1:1006–1015. https://doi.org/10.2215/CJN.01941205 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Furth SL, Pierce C, Hui WF, White CA, Wong CS, Schaefer F, Wuhl E, Abraham AG, Warady BA, Chronic Kidney Disease in Children (CKiD); Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators (2018) Estimating time to ESRD in children with CKD. Am J Kidney Dis 71:783–792. https://doi.org/10.1053/j.ajkd.2017.12.011 CrossRefPubMedGoogle Scholar
- 21.ESCAPE Trial Group, Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Moller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650. https://doi.org/10.1056/NEJMoa0902066 CrossRefGoogle Scholar