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Predictors and consequences of higher estimated glomerular filtration rate at dialysis initiation

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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.

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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.

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Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Meredith A. Atkinson, Alicia M. Neu & Barbara A. Fivush

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Pooja C. Oberai

  3. The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Rulan S. Parekh

  4. Pediatric Nephrology, Johns Hopkins University, 200 N. Wolfe St., Baltimore, MD, 21287-2535, USA

    Meredith A. Atkinson

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  1. Meredith A. Atkinson
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  2. Pooja C. Oberai
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Correspondence to Meredith A. Atkinson.

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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

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  • DOI: https://doi.org/10.1007/s00467-010-1459-4

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