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Published on: June 23, 2015
Prospective cohort analyzing risk factors for chronic kidney disease progression in children
Vera M S Belangero1, Liliane C Prates1, Andreia Watanabe2
1Universidade Estadual de Campinas (UNICAMP), Nefrologia Pediátrica, Campinas, SP, Brazil.
Insights
This study identified key risk factors for chronic kidney disease (CKD) progression in Brazilian children, including advanced stage, proteinuria, age, blood pressure, and anemia. Anemia may be more detrimental in children without proteinuria, warranting further investigation.
Area of Science:
- Pediatric Nephrology
- Chronic Kidney Disease Epidemiology
- Risk Factor Analysis
Background:
- Chronic kidney disease (CKD) poses a significant health challenge in children.
- Identifying progression risk factors is crucial for timely intervention and management.
- Limited data exists on CKD progression in pediatric populations in the Southern Hemisphere.
Purpose of the Study:
- To identify risk factors associated with CKD progression in Brazilian children.
- To investigate interactions between identified risk factors.
- To provide data for developing strategies to slow CKD evolution in pediatric patients.
Main Methods:
- A multicenter prospective cohort study involving 209 children with CKD stages 3-4 in São Paulo.
- Outcomes included death, initiation of kidney replacement therapy, or a >50% decrease in estimated glomerular filtration rate (eGFR).
- Univariate and multivariable Cox regression models were used to analyze 13 risk factors and their interactions.
Main Results:
- The composite outcome occurred in 21% of children over a median follow-up of 2.5 years.
- Significant risk factors for CKD progression were advanced CKD stage, nephrotic proteinuria, age, systolic blood pressure Z-score, and anemia.
- A significant interaction was found between anemia and nephrotic proteinuria, suggesting anemia may be more detrimental in patients without proteinuria.
Conclusions:
- This study, the first CKD cohort in the Southern Hemisphere, confirms risk factors similar to those reported in developed countries.
- Findings support the potential for therapeutic interventions to slow CKD progression in children.
- The interaction between anemia and proteinuria requires further research to elucidate its clinical implications.
Objective:
To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors.
Methods:
This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3-4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model.
Results:
After a median follow-up of 2.5 years (IQR=1.4-3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR=2.16, CI=1.14-4.09), nephrotic proteinuria (HR=2.89, CI=1.49-5.62), age (HR=1.10, CI=1.01-1.17), systolic blood pressure Z score (HR=1.36, CI=1.08-1.70), and anemia (HR=2.60, CI=1.41-4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR=0.25, CI=0.06-1.00) was detected.
Conclusions:
As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied.
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