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Prediction of kidney failure in children with chronic kidney disease and obstructive uropathy

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Abstract

Background

Obstructive uropathy (OU) is a leading cause of pediatric kidney injury. Accurate prediction of kidney disease progression may improve clinical outcomes. We aimed to examine discrimination and accuracy of a validated kidney failure risk equation (KFRE), previously developed in adults, in children with OU.

Methods

We identified 118 children with OU and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in the Chronic Kidney Disease in Children study, a national, longitudinal, observational cohort. Each patient’s 5-year risk of kidney failure was estimated using baseline data and published parameters for the 4- and 8-variable KFREs. Discriminative ability of the KFRE was estimated using the C statistic for time-to-event analysis. Sensitivity and specificity were evaluated across varying risk thresholds.

Results

Among the 118 children, 100 (85%) were boys, with median baseline age of 10 years (interquartile range, 6–14). Median eGFR was 42 mL/min/1.73m 2 (32–53), with a median follow-up duration of 4.5 years (2.7–7.2); 23 patients (19.5%) developed kidney failure within 5 years. The 4-variable KFRE discriminated kidney failure risk with a C statistic of 0.75 (95% CI, 0.68–0.82). A 4-variable risk threshold of ≥ 30% yielded 82.6% sensitivity and 75.0% specificity. Results were similar using the 8-variable KFRE.

Conclusions

In children with OU, the KFRE discriminated the 5-year risk of kidney failure at C statistic values lower than previously published in adults but comparable with suboptimal values reported in the overall CKiD population. The 8-variable equation did not improve model discrimination or accuracy, suggesting the need for continued research into additional, disease-specific markers.

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Acknowledgments

The Chronic Kidney Disease in Children Cohort Study (CKiD) was conducted by the CKiD investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 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, U24DK-082194, U24-DK-66116). The data from the CKiD study reported here were supplied by the NIDDK Central Repositories.

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Authors and Affiliations

  1. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Yuri V. Sebastião, Jennifer N. Cooper & Daryl J. McLeod

  2. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Jennifer N. Cooper

  3. Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA

    Jennifer N. Cooper

  4. Center For Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Brian Becknell & Christina B. Ching

  5. Department of Pediatrics, Section of Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA

    Brian Becknell

  6. Department of Pediatric Urology, Nationwide Children’s Hospital, Columbus, OH, USA

    Christina B. Ching & Daryl J. McLeod

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  1. Yuri V. Sebastião
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  2. Jennifer N. Cooper
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  5. Daryl J. McLeod
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Correspondence to Daryl J. McLeod.

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This specific study was exempt from IRB review owing to its use of only de-identified data.

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The authors declare that they have no conflict of interest.

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Sebastião, Y.V., Cooper, J.N., Becknell, B. et al. Prediction of kidney failure in children with chronic kidney disease and obstructive uropathy. Pediatr Nephrol 36, 111–118 (2021). https://doi.org/10.1007/s00467-020-04661-w

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  • DOI: https://doi.org/10.1007/s00467-020-04661-w

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