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A predictive model of progression of CKD to ESRD in a predialysis pediatric interdisciplinary program
Debora C Cerqueira1, Cristina M Soares, Vanessa R Silva
1Department of Pediatrics, Pediatric Nephrourology Unit,, †Nutrition Division, and, ‡Department of Statistics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Insights
This study developed a predictive model to identify children with chronic kidney disease (CKD) at high risk for end-stage renal disease (ESRD). The model accurately predicts accelerated renal failure, aiding early intervention for pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Clinical Epidemiology
- Biostatistics
Background:
- Increasing incidence of end-stage renal disease (ESRD) in children over the past two decades.
- Limited understanding of risk factors for ESRD development in pediatric chronic kidney disease (CKD) patients.
- Need for predictive tools to manage CKD progression in children.
Purpose of the Study:
- To develop a predictive model for ESRD in children and adolescents (CKD stages 2-4) in a predialysis program.
- To identify key risk factors associated with accelerated renal failure in pediatric CKD.
- To enable early identification of high-risk patients for timely intervention.
Main Methods:
- Retrospective cohort study of 147 pediatric CKD patients (1990-2008) followed for a median of 4.5 years.
- Primary outcome: progression to CKD stage 5 (ESRD).
- Cox proportional hazards model used to develop the predictive model, evaluated by c-statistics.
Main Results:
- Median renal survival was 98.7 months; 52% probability of reaching CKD stage 5 within 10 years.
- The most accurate predictive model incorporated estimated glomerular filtration rate (eGFR), proteinuria, and primary renal disease.
- High accuracy (c-statistics 0.865 and 0.837 at 2 and 5 years) and significant risk stratification observed.
Conclusions:
- The developed predictive model can identify pediatric CKD patients at high risk for rapid progression to ESRD.
- Early identification facilitates targeted management strategies to slow renal failure.
- This tool supports proactive care in pediatric nephrology units.
Background And Objectives:
The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program.
Design, Setting, Participants, & Measurements:
In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics.
Results:
The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001).
Conclusion:
The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
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