The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease
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We sought to describe rates of kidney function decline and to identify modifiable risk factors for CKD progression in a multicenter prospective cohort study of adolescents with CKD aged 11 to 18 years seen semiannually for up to three years. Of the 23 subjects meeting inclusion criteria, the average estimated GFR was 51 ± 27 ml/min/1.73 m2 (0.85 ± 0.45 ml/s/1.73 m2) at entry. The overall annualized decline in GFR was 5.6 ml/min/1.73 m2 (0.093 ml/s/1.73 m2) per year (95% confidence interval [95% CI]: 1.9 to 9.3 [0.032 to 0.16]). The adjusted annualized decline in GFR was found to be accelerated in males, as well as among those over 15 years of age. The adjusted annualized decline in GFR was greater among those with either anemia (hematocrit below 36%), or hypoalbuminemia (albumin below 4 g/dl [40 g/L]). After adjustment, anemia was associated with an accelerated decline of 7.8 ml/min/1.73 m2 (0.13 ml/s/1.73 m2) (95% CI: 3.3 to 12 [0.055 to 0.20]) and hypoalbuminemia was associated with an accelerated decline of 17 ml/min/1.73 m2 (0.28 ml/s/1.73 m2) (95% CI: 11 to 22 [0.18 to 0.37]). Further study is needed to evaluate whether treatment of anemia or hypoalbuminemia, as outlined in current clinical care guidelines for CKD, may slow the progression of CKD in adolescents.
KeywordsPediatrics Chronic kidney disease Progression Anemia Hypoalbuminemia
This study was presented in part at the Pediatric Academic Society Meeting, May, 2004, Washington D.C. The Functional Outcomes in Adolescents Study was funded in part by The Kidney and Urology Foundation of America. Dr. Furth is supported in part by UO1-DK-66174 (Chronic Kidney Disease in Children cohort study (CKiD) by the National Institute of Diabetes, Digestive and Kidney Disorders, with additional funding from the National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute. Dr. Cole was supported in part by the National Institutes of Health through the data coordinating center for CKiD (UO1-DK-066116). The CKID website is located at http://www.statepi.jhsph.edu. Dr. Fadrowski was supported by the American Kidney Fund’s Clinical Scientist in Nephrology Fellowship Program.
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