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Common clinical markers predict end-stage renal disease in children with obstructive uropathy

  • Daryl J. McLeod
  • Christina B. Ching
  • Yuri V. Sebastião
  • Jason H. Greenberg
  • Susan L. Furth
  • Kirk M. McHugh
  • Brian Becknell
Original Article
Part of the following topical collections:
  1. What’s New in Chronic Kidney Disease

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

Age-specific baseline and longitudinal measures of readily available clinical measures predict progression to ESRD in children with mild-to-moderate CKD from OU.

Keywords

Obstruction Uropathy Chronic kidney disease End-stage renal disease Prediction CKiD 

Notes

Acknowledgments

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.

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Daryl J. McLeod
    • 1
    • 2
  • Christina B. Ching
    • 1
    • 3
  • Yuri V. Sebastião
    • 2
  • Jason H. Greenberg
    • 4
  • Susan L. Furth
    • 5
  • Kirk M. McHugh
    • 3
    • 6
  • Brian Becknell
    • 3
    • 7
  1. 1.Section of UrologyNationwide Children’s HospitalColumbusUSA
  2. 2.Center for Surgical Outcomes ResearchNationwide Children’s HospitalColumbusUSA
  3. 3.Center for Clinical and Translational ResearchNationwide Children’s HospitalColumbusUSA
  4. 4.Department of Pediatrics, Section of NephrologyYale University School of MedicineNew HavenUSA
  5. 5.Department of Pediatrics, Division of NephrologyPerelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  6. 6.Department of Biomedical Education & AnatomyOhio State University College of MedicineColumbusUSA
  7. 7.Department of Pediatrics, Section of NephrologyNationwide Children’s HospitalColumbusUSA

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