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Predictive factors of progression of chronic renal insufficiency: a multivariate analysis
Cristina M Bouissou Soares1, Eduardo A Oliveira, José Silvério S Diniz
1Pediatric Nephrourology Unit, Department of Pediatrics, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Insights
In children with chronic kidney disease, a low glomerular filtration rate (GFR) and severe proteinuria independently predict progression to end-stage renal failure (ESRF). Early identification of these factors aids in managing pediatric renal insufficiency.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Chronic Kidney Disease Research
Background:
- Chronic renal insufficiency affects children and adolescents, necessitating identification of factors influencing its progression.
- Understanding progression predictors is crucial for managing pediatric patients towards conservative management and preventing end-stage renal failure (ESRF).
Purpose of the Study:
- To identify clinical, nutritional, and laboratory factors associated with the rate of progression of chronic renal insufficiency in pediatric patients.
- To determine independent predictors of progression to end-stage renal failure (ESRF) in children and adolescents managed conservatively.
Main Methods:
- Prospective cohort study of 62 children and adolescents (2 months to 19 years) with chronic renal failure.
- Analysis included clinical data, nutritional status (Z scores for weight and height), and laboratory markers like glomerular filtration rate (GFR) and proteinuria.
- Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of progression to ESRF.
Main Results:
- Twenty-one percent (34%) of patients progressed to ESRF over a median follow-up of 43 months.
- Independent predictors of ESRF progression were a glomerular filtration rate (GFR) under 30 ml/min and severe proteinuria.
- The combination of low GFR and severe proteinuria indicated a significantly worse prognosis.
Conclusions:
- Glomerular filtration rate (GFR) below 30 ml/min and severe proteinuria are independent predictors of ESRF progression in pediatric chronic renal insufficiency.
- These factors are critical for risk stratification and management strategies in children and adolescents with chronic kidney disease.
- Early identification of these indicators can guide interventions to slow disease progression in pediatric renal insufficiency.
Abstract:
The purpose of this study was to identify clinical, nutritional, and laboratory factors associated with the rate of progression of chronic renal insufficiency among children and adolescents admitted to a pre-end-stage renal failure (ESRF) interdisciplinary program. Sixty-two children and adolescents aged 2 months to 19 years with chronic renal failure on conservative management were prospectively followed from 1990 to 1999. The following variables were analyzed: age at admission, sex, race, blood pressure, primary renal disease, Z scores for weight and height, glomerular filtration rate (GFR), urea, and presence and degree of proteinuria. Progression to ESRF was assigned as a dependent variable. The analysis was conducted in two steps. In a univariate analysis, variables associated with ESRF outcome were identified by the log-rank test. Then, the variables that were significantly associated with adverse outcome were included in a multivariate analysis. This analysis, using the Cox proportional hazards model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. Twenty-one (34%) patients evolved to ESRF during a median follow-up of 43 months. Two variables were identified as independent predictors of progression to ESRF: GFR under 30 ml/min (RR=3, 95% CI=1.7-5.3, P=0.0001) and severe proteinuria (RR=3.1, 95% CI=1.2-7.6, P=0.01). The combination of two factors-GFR lower than 30 ml/min and presence of severe proteinuria on admission-was an independent indicator of adverse outcome in children and adolescents with chronic renal insufficiency who were conservatively managed.