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Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program

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Abstract

The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan–Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38–145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m2 body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m2 per year (IQ range −24 to −5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, and miscellanea were 2.5 ml/min (IQ range −10 to +0.34), 2.2 ml/min (IQ range −5.0 to −0.52), and 0.36 ml/min (IQ range −2.5 to +2.6), respectively (P < 0.001). The results of this study support the view that children and adolescents with glomerular diseases present a faster deterioration of renal function. Therefore, patients with glomerular diseases need to be referred early to a pediatric nephrology center so that suboptimal pre-dialysis care might possibly be avoided.

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References

  1. Mak RH (2007) Chronic kidney disease in children: state of the art. Pediatr Nephrol 22:1687–1688

    Article  Google Scholar 

  2. Warady BA, Chadha V (2007) Chronic kidney disease in children: the global perspective. Pediatr Nephrol 22:1999–2009

    Article  Google Scholar 

  3. Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, Wong C, Muñoz 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

    Article  Google Scholar 

  4. Chesney RW, Brewer E, Moxey-Mims M, Watkins S, Furth SL, Harmon WE, Fine RN, Portman RJ, Warady BA, Salusky IB, Langman CB, Gipson D, Scheidt P, Feldman H, Kaskel FJ, Siegel NJ (2006) Report of an NIH task force on research priorities in chronic kidney disease in children. Pediatr Nephrol 21:14–25

    Article  Google Scholar 

  5. Van Dyck M, Sidler S, Proesmans W (1998) Chronic renal failure in infants: effect of strict conservative treatment on growth. Eur J Pediatr 157:759–762

    Article  Google Scholar 

  6. Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L (2000) Outcome and growth of infants with severe chronic renal failure. Kidney Int 57:1681–1687

    Article  CAS  Google Scholar 

  7. Wingen AM, Fabian-Bach C, Schaefer F, Mehls O (1997) Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet 349:1117–1123

    Article  CAS  Google Scholar 

  8. Litwin M (2004) Risk factors for renal failure in children with non-glomerular nephropathies. Pediatr Nephrol 19:178–186

    Article  Google Scholar 

  9. Moore E, Aronson A, Northrup T (1986) The assessment of renal function. In: Pediatric nephrology, 1st edn. Wright, Bristol, pp 404–411

    Google Scholar 

  10. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  11. Soares CM, Oliveira EA, Diniz JS, Lima EM, Vasconcelos MM, Oliveira GR (2003) Predictive factors of progression of chronic renal insufficiency: a multivariate analysis. Pediatr Nephrol 18:371–377

    Article  Google Scholar 

  12. IBGE: Censo 2000, vol 2007. Brazilian Institute of Geography and Statistics, 2000. https://doi.org/www.ibge.gov.br/home/estatistica/populacao/censo2000

  13. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  14. Centers for Disease Control and Prevention (CDC) (2007) Epi Info https://doi.org/www.cdc.gov/epiinfo/

  15. Institute of Medicine, Food, and Nutrition Board (2003) Dietary reference intakes. Applications in dietary planning. National Academy Press, Washington DC

    Google Scholar 

  16. Abrantes MM, Cardoso LS, Lima EM, Penido Silva JM, Diniz JS, Bambirra EA, Oliveira EA (2006) Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis. Pediatr Nephrol 21:1003–1012

    Article  Google Scholar 

  17. Silva JM, Santos Diniz JS, Marino VS, Lima EM, Cardoso LS, Vasconcelos MA, Oliveira EA (2006) Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21:981–988

    Article  Google Scholar 

  18. Litwin M, Grenda R, Prokurat S, Abuauba M, Latoszynska J, Jobs K, Boguszewska-Baczkowska A, Wawer ZT (2001) Patient survival and causes of death on hemodialysis and peritoneal dialysis: single-center study. Pediatr Nephrol 16:996–1001

    Article  CAS  Google Scholar 

  19. Warady BA, Hebert D, Sullivan EK, Alexander SR, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:49–64

    Article  CAS  Google Scholar 

  20. Seikaly MG, Salhab N, Warady BA, Stablein D (2007) Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS. Pediatr Nephrol 22:1195–1204

    Article  Google Scholar 

  21. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G (1994) The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 330:877–884

    Article  CAS  Google Scholar 

  22. Furth SL, Cole SR, Fadrowski JJ, Gerson A, Pierce CB, Chandra M, Weiss R, Kaskel F (2007) The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease. Pediatr Nephrol 22:265–271

    Article  Google Scholar 

  23. Locatelli F, Alberti D, Graziani G, Buccianti G, Redaelli B, Giangrande A, Marcelli D, Francucci BM (1992) Factors affecting chronic renal failure progression: results from a multicentre trial. The Northern Italian Cooperative Study Group. Miner Electrolyte Metab 18:295–302

    CAS  PubMed  Google Scholar 

  24. Gonzalez Celedon C, Bitsori M, Tullus K (2007) Progression of chronic renal failure in children with dysplastic kidneys. Pediatr Nephrol 22:1014–1020

    Article  Google Scholar 

  25. Locatelli F, Marcelli D, Comelli M, Alberti D, Graziani G, Buccianti G, Redaelli B, Giangrande A, Northern Italian Cooperative Study Group (1996) Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Nephrol Dial Transplant 11:461–467

    Article  CAS  Google Scholar 

  26. Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, Rogers NL, Teschan PE (1997) Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int 51:1908–1919

    Article  CAS  Google Scholar 

  27. Postlethwaite RJ, Eminson DM, Reynolds JM, Wood AJ, Hollis S (1998) Growth in renal failure: a longitudinal study of emotional and behavioural changes during trials of growth hormone treatment. Arch Dis Child 78:222–229

    Article  CAS  Google Scholar 

  28. Furth SL, Stablein D, Fine RN, Powe NR, Fivush BA (2002) Adverse clinical outcomes associated with short stature at dialysis initiation: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 109:909–913

    Article  Google Scholar 

  29. Furth SL, Hwang W, Yang C, Neu AM, Fivush BA, Powe NR (2002) Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr Nephrol 17:450–455

    Article  Google Scholar 

  30. Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799

    Article  Google Scholar 

  31. Mahan JD, Warady BA (2006) Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol 21:917–930

    Article  Google Scholar 

  32. Ledermann SE, Shaw V, Trompeter RS (1999) Long-term enteral nutrition in infants and young children with chronic renal failure. Pediatr Nephrol 13:870–875

    Article  CAS  Google Scholar 

  33. Zivicnjak M, Franke D, Filler G, Haffner D, Froede K, Nissel R, Haase S, Offner G, Ehrich JH, Querfeld U (2007) Growth impairment shows an age-dependent pattern in boys with chronic kidney disease. Pediatr Nephrol 22:420–429

    Article  Google Scholar 

  34. Sylvestre LC, Fonseca KP, Stinghen AE, Pereira AM, Meneses RP, Pecoits-Filho R (2007) The malnutrition and inflammation axis in pediatric patients with chronic kidney disease. Pediatr Nephrol 22:864–873

    Article  Google Scholar 

  35. Bakr A, Amr M, Sarhan A, Hammad A, Ragab M, El-Refaey A, El-Mougy A (2007) Psychiatric disorders in children with chronic renal failure. Pediatr Nephrol 22:128–131

    Article  Google Scholar 

  36. Boehm M, Riesenhuber A, Winkelmayer WC, Arbeiter K, Mueller T, Aufricht C (2007) Early erythropoietin therapy is associated with improved growth in children with chronic kidney disease. Pediatr Nephrol 22:1189–1193

    Article  Google Scholar 

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Acknowledgments

This study was partially supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The authors owe special thanks to the team of the pre-dialysis interdisciplinary management program (HC-UFMG), Vanessa Rodrigues da Silva, Andréa Marques Chiaretti Munaier, and Marilene Moreira, for their inestimable participation in the care of our patients.

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Authors and Affiliations

  1. Pediatric Nephrourology Unit, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Cristina M. Bouissou Soares, José Silvério S. Diniz, Eleonora M. Lima, Jose M. Penido Silva, Gilce R. Oliveira, Monica R. Canhestro, Ana Cristina Simoes e Silva & Eduardo A. Oliveira

  2. Department of Statistics, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Enrico A. Colosimo

  3. Rua Engenheiro Amaro Lanari 389/501, Belo Horizonte, Minas Gerais, 30.310.580, Brazil

    Eduardo A. Oliveira

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  1. Cristina M. Bouissou Soares
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  2. José Silvério S. Diniz
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  3. Eleonora M. Lima
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  4. Jose M. Penido Silva
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  5. Gilce R. Oliveira
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  6. Monica R. Canhestro
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  7. Enrico A. Colosimo
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  8. Ana Cristina Simoes e Silva
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  9. Eduardo A. Oliveira
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Correspondence to Eduardo A. Oliveira.

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Soares, C.M.B., Diniz, J.S.S., Lima, E.M. et al. Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program. Pediatr Nephrol 23, 2039–2046 (2008). https://doi.org/10.1007/s00467-008-0868-0

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  • DOI: https://doi.org/10.1007/s00467-008-0868-0

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