Predictive factors of progression to chronic kidney disease stage 5 in a predialysis interdisciplinary programme

Area of Science:

• Pediatric Nephrology
• Renal Medicine
• Clinical Epidemiology

Background:

• The clinical trajectory of chronic kidney disease (CKD) in pediatric populations is highly variable and not fully understood.
• Predicting CKD progression is essential for timely intervention and management in children.

Purpose of the Study:

• To identify factors that predict the progression of chronic kidney disease (CKD) to stage 5 in children and adolescents.
• To analyze baseline and time-dependent variables influencing CKD progression within a Predialysis Interdisciplinary Management Programme (PDIMP).

Main Methods:

• Retrospective cohort study involving 107 pediatric patients with CKD stages 2-4.
• Analysis of baseline variables including age, gender, race, blood pressure, primary renal disease, anthropometric Z-scores, CKD stage, and proteinuria.
• Time-fixed and time-dependent Cox regression models were used to assess predictors of progression to CKD stage 5, considering hypertension and proteinuria as time-dependent covariates.

Main Results:

• Over a median follow-up of 94 months, 53.3% of patients progressed to CKD stage 5.
• Independent predictors of CKD stage 5 identified in the time-fixed model were glomerular disease, CKD stage 4, and severe proteinuria.
• In the time-dependent model, significant predictors included proteinuria, CKD stage 4, and baseline serum albumin <3.5 g/dL.

Conclusions:

• Baseline CKD stage 4, glomerular disease, and severe proteinuria are significant predictors of progression to end-stage renal disease in children.
• Proteinuria and low baseline serum albumin are also critical factors when considered as time-dependent variables.
• Further prospective studies are needed to evaluate interventions targeting these modifiable factors to alter the course of pediatric CKD.