Abstract
There have been no studies in pediatric dialysis patients to evaluate the impact of higher estimated glomerular filtration rate (eGFR) at dialysis initiation on clinical outcomes. Baseline clinical and demographic information was collected for children aged 1–18 years undergoing incident dialysis from 1995–2002 within the United States Renal Data System. Baseline eGFRs calculated by the Schwartz formula were categorized as high (>15 ml/min/1.73 m2) or low (≤15 ml/min/1.73 m2). We determined predictors of eGFR at baseline, and associations between baseline eGFR and subsequent hospitalization for hypertension (HTN) or pulmonary edema (PE) in a longitudinal nonconcurrent pediatric end-stage renal disease (ESRD) cohort. Twenty percent of children had a high eGFR at initiation. Black children were less likely to initiate dialysis with a high eGFR [adjusted odds ratio (adjOR) 0.71, p < 0.001]. Girls were less likely to have a high eGFR at baseline (adjOR 0.71, p < 0.001). Children who received predialysis erythropoietin therapy were more likely to start dialysis with a high eGFR (adjOR 6.67, p < 0.001). Children with higher baseline eGFR were found to have a 21% decreased risk of hospitalization [adjusted hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65–0.96, p = 0.02]. It is not known whether this clinical benefit will result in decreased mortality and complication rates from cardiovascular disease.
Similar content being viewed by others
References
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147
Seikaly MG, Salhab N, Browne R (2005) Patterns and time of initiation of dialysis in US children. Pediatr Nephrol 20:982–988
Leonard MB, Donaldson LA, Ho M, Geary DF (2003) A prospective cohort study of incident maintenance dialysis in children: an NAPRTC study. Kidney Int 63:744–755
Chandna SM, Farrington K (2004) Residual renal function: considerations on its importance and preservation in dialysis patients. Semin Dial 17:196–201
Shemin D, Bostom AG, Lambert C, Hill C, Kitsen J, Kliger AS (2000) Residual renal function in a large cohort of peritoneal dialysis patients: change over time, impact on mortality and nutrition. Perit Dial Int 20:439–444
Perl J, Bargman JM (2009) The importance of residual kidney function for patients on dialysis: a critical review. Am J Kidney Dis 53:1068–1081
Traynor JP, Simpson K, Geddes CC, Deighan CJ, Fox JG (2002) Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure. J Am Soc Nephrol 13:2125–2132
Kim SG, Kim NH (2009) The effect of residual renal function at the initiation of dialysis on patient survival. Korean J Intern Med 24:55–62
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
Mitsnefes MM (2005) Cardiovascular morbidity and mortality in children with chronic kidney disease in North America: lessons from the USRDS and NAPRTCS databases. Perit Dial Int 25:S120–S122
Mitsnefes M, Stablein D (2005) Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis 45:309–315
Groothoff JW (2005) Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 20:849–853
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590
Wilchesky M, Tamblyn RM, Huang A (2004) Validation of diagnostic codes within medical services claims. J Clin Epidemiol 57:131–141
Stata Statistical Software: Release 8.0 [computer program]. College Station, TX: Stata Corporation; 2002
Ifudu O, Dawood M, Iofel Y, Valcourt JS, Friedman EA (1999) Delayed referral of black, Hispanic, and older patients with chronic renal failure. Am J Kidney Dis 33:728–733
Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ (2000) Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol 11:2351–2357
Iofel Y, Dawood M, Valcourt JS, Ifudu O (1998) Initiation of dialysis is not delayed in whites with progressive renal failure. ASAIO J 44:598–600
Kazmi WH, Obrador GT, Khan SS, Pereira BJ, Kausz AT (2004) Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis. Nephrol Dial Transplant 19:1808–1814
Winkelmayer WC, Owen WF Jr, Levin R, Avorn J (2003) A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol 14:486–492
Cass A, Cunningham J, Arnold PC, Snelling P, Wang Z, Hoy W (2002) Delayed referral to a nephrologist: outcomes among patients who survive at least one year on dialysis. Med J Aust 177:135–138
Obialo CI, Ofili EO, Quarshie A, Martin PC (2005) Ultralate referral and presentation for renal replacement therapy: socioeconomic implications. Am J Kidney Dis 46:881–886
Arora P, Obrador GT, Ruthazer R, Kausz AT, Meyer KB, Jenuleson CS, Pereira BJ (1999) Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol 10:1281–1286
Malyszko J, Malyszko JS, Kozminski P, Mysliwiec M (2009) Type of renal replacement therapy and residual renal function may affect prohepcidin and hepcidin. Ren Fail 31:876–883
Gruppen MP, Groothoff JW, Prins M, van der Wouw P, Offringa M, Bos WJ, Davin JC, Heymans HS (2003) Cardiac disease in young adult patients with end-stage renal disease since childhood: a Dutch cohort study. Kidney Int 63:1058–1065
Chavers B, Schnaper HW (2001) Risk factors for cardiovascular disease in children on maintenance dialysis. Adv Ren Replace Ther 8:180–190
Holtta T, Happonen JM, Ronnholm K, Fyhrquist F, Holmberg C (2001) Hypertension, cardiac state, and the role of volume overload during peritoneal dialysis. Pediatr Nephrol 16:324–331
Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, Wolfe RA, Hulbert-Shearon T, Jones CA, Bloembergen WE (2000) Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol 11:556–564
Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT (2002) Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 62:1046–1053
Feber J, Scharer K, Schaefer F, Mikova M, Janda J (1994) Residual renal function in children on haemodialysis and peritoneal dialysis therapy. Pediatr Nephrol 8:579–583
Mattman A, Eintracht S, Mock T, Schick G, Seccombe DW, Hurley RM, White CT (2006) Estimating pediatric glomerular filtration rates in the era of chronic kidney disease staging. J Am Soc Nephrol 17:487–496
Hellerstein S, Berenbom M, DiMaggio S, Erwin P, Simon SD, Wilson N (2004) Comparison of two formulae for estimation of glomerular filtration rate in children. Pediatr Nephrol 19:780–784
Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE (1996) The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis 28:53–61
Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM (1993) The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 329:1001–1006
Acknowledgements
Dr. Atkinson received support from the National Institutes of Health Research Training Program Grants # T32 HL07024 and T32 HD044335, and the National Kidney Foundation. Dr. Parekh was supported by 1UO1-DK-57304-01 and R01 DK72367-01A2. The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author and in no way should be seen as an official policy or interpretation of the US government.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Atkinson, M.A., Oberai, P.C., Neu, A.M. et al. Predictors and consequences of higher estimated glomerular filtration rate at dialysis initiation. Pediatr Nephrol 25, 1153–1161 (2010). https://doi.org/10.1007/s00467-010-1459-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-010-1459-4