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Insignificant impact of VUR on the progression of CKD in children with CAKUT

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Abstract

Background

Vesicoureteral reflux (VUR) is associated with an increased risk of kidney disorders. It is unclear whether VUR is associated with progression from chronic kidney disease (CKD) to end-stage kidney disease (ESKD) in children with congenital anomalies of the kidney and urinary tract (CAKUT).

Methods

We conducted a 3-year follow-up survey of a cohort of 447 children with CKD (stage 3–5). Rates of and risk factors for progression to ESKD were determined using the Kaplan–Meier method and Cox regression respectively.

Results

Congenital anomaly of the kidney and urinary tract was the primary etiology in 278 out of 447 children; 118 (42.4 %) had a history of VUR at the start of the cohort study. There were significantly more boys than girls with VUR, whereas the proportions were similar in children without VUR. The types of urinary anomalies/complications of the two groups were significantly different. Three-year renal survival rates of the groups were not significantly different, irrespective of CKD stage. Age  < 2 years and age after puberty, stage 4 or 5 CKD, and heavy proteinuria, but not history of VUR, were significantly associated with progression to ESKD.

Conclusions

History of VUR at the start of follow-up was not associated with the progression of stage 3–5 CKD in children with CAKUT.

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Acknowledgements

The authors would like to thank Drs Takuhito Nagai (Aichi), Kenichi Satomura (Osaka), Tomoo Kise (Okinawa), Takuji Yamada (Aichi), Midori Awazu (Tokyo), Hiroshi Asanuma (Tokyo), Toshiyuki Ohta (Hiroshima), Takeshi Matsuyama (Tokyo), Hidefumi Nakamura (Tokyo), Mayumi Sako (Tokyo), Tomoyuki Sakai (Shiga), Yusuke Okuda (Shiga), Shunsuke Shinozuka (Saitama), Yoshinobu Nagaoka (Hokkaido), Shuichiro Fujinaga (Saitama), Hiroshi Kitayama (Shizuoka), Naoya Fujita (Shizuoka), Masataka Hisano (Chiba), Daishi Hirano (Tokyo), Yuko Akioka (Tokyo), Naoaki Mikami (Tokyo), Hiroshi Hataya (Tokyo), Hiroyuki Satoh (Tokyo), Tae Omori (Tokyo), Takashi Sekine (Tokyo), Yoshimitsu Goto (Aichi), Yohei Ikezumi (Niigata), Takeshi Yamada (Niigata), and Akira Matsunaga (Yamagata) of The Pediatric CKD Study Group in Japan for their contributions to the study. The authors would also like to thank all the institutions that participated in the surveys listed in the Supplement, and Mr Masaaki Kurihara, Ms Chie Matsuda, Ms Naomi Miyamoto, and Ms Takako Arai of the Japan Clinical Research Support Unit (Tokyo) for their help with data management; Dr Naoaki Mikami and Ms Sachiko Kawabe of Tokyo Metropolitan Children’s Medical Center for their contribution to manuscript preparation; and Nicholas Smith, PhD, of Edanz Group Ltd., for providing language editorial support in the preparation of the manuscript. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Ethics

The study was conducted in accordance with the principles of the Declaration of Helsinki and the ethical guidelines issued by the Ministry of Health, Labour, and Welfare, Japan. The study was approved by the ethics committee of the Tokyo Metropolitan Children’s Medical Center (ID: 23–49). Because data were reported using patient medical records, informed consent was not obtained in accordance with the above guidelines.

Funding

This work was supported by a Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases from the Ministry of Health, Labour, and Welfare, Japan (H25-nanchitou(nan)-ippan-017 and H26-nanchitou(nan)-ippan-036) and the 2013 Tokyo Metropolitan Hospitals’ Clinical Research Fund (Special Research).

Conflict of interest

Kenji Ishikura has received lecture fees from Novartis Pharma and Asahi Kasei Pharma. Osamu Uemura has received lecture fees from Asahi Kasei Pharma, Kyowa Hakko Kirin, Takeda Pharmaceutical, and Siemens Group in Japan. Yuko Hamasaki has received research grants from Novartis Pharma, and lecture fees from Novartis Pharma, Astellas Pharma, and Pfizer Japan. Hideo Nakai has received a research grant from Astellas Pharma. Ryojiro Yasuo Ohashi has received research grants from Kyowa Hakko Kirin and Chugai pharmaceutical. Tanaka has received lecture fees from Pfizer Japan and Asahi Kasei Pharma. Koichi Nakanishi has received lecture fees from Novartis Pharma, Asahi Kasei Pharma, and Astellas Pharma. Kazumoto Iijima has received research grants from Novartis and Pfizer Japan, and lecture fees from Novartis, Asahi Kasei Pharma, and Pfizer Japan. Masataka Honda has received lecture fees from Novartis Pharma, Asahi Kasei Pharma, Takeda Pharmaceutical, and Chugai Pharmaceutical. Drs Ito, Harada, Hattori, and Mr Kaneko have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kenji Ishikura

  2. Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Kenji Ishikura, Ryoko Harada & Masataka Honda

  3. Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Aichi, Japan

    Osamu Uemura

  4. Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan

    Yuko Hamasaki

  5. Department of Pediatric Urology, Jichi Medical University, Children’s Medical Center, Tochigi, Japan

    Hideo Nakai

  6. Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan

    Shuichi Ito

  7. Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan

    Motoshi Hattori

  8. Department of Integrated Science and Engineering for Sustainable Society, Faculty of Science and Engineering, Chuo University, Tokyo, Japan

    Yasuo Ohashi

  9. Department of Nephrology, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan

    Ryojiro Tanaka

  10. Department of Pediatrics, Wakayama Medical University, Wakayama, Japan

    Koichi Nakanishi

  11. Division of Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Tetsuji Kaneko

  12. Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Kazumoto Iijima

  13. Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Aichi, Japan

    Osamu Uemura

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  1. Kenji Ishikura
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  2. Osamu Uemura
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  3. Yuko Hamasaki
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  4. Hideo Nakai
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  7. Motoshi Hattori
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  8. Yasuo Ohashi
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  9. Ryojiro Tanaka
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  10. Koichi Nakanishi
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  11. Tetsuji Kaneko
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  12. Kazumoto Iijima
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  13. Masataka Honda
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Consortia

on behalf of the Pediatric CKD Study Group in Japan in conjunction with the Committee of Measures for Pediatric CKD of the Japanese Society for Pediatric Nephrology

Corresponding author

Correspondence to Kenji Ishikura.

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ESM 3

Renal survival rates at 3 years according to the stage of chronic kidney disease (CKD) and surgical treatment of vesicoureteral reflux. (GIF 2310 kb)

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Ishikura, K., Uemura, O., Hamasaki, Y. et al. Insignificant impact of VUR on the progression of CKD in children with CAKUT. Pediatr Nephrol 31, 105–112 (2016). https://doi.org/10.1007/s00467-015-3196-1

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  • DOI: https://doi.org/10.1007/s00467-015-3196-1

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