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Renal Replacement Therapy and Intermittent Catheterization Risk in Posterior Urethral Valves
Daryl J McLeod1, Konrad M Szymanski2, Edward Gong3
1Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Posterior urethral valves increase risk for renal replacement therapy (RRT) and bladder dysfunction. Early serum creatinine levels can predict RRT risk in children, aiding management strategies.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Research
Background:
- Posterior urethral valves (PUV) are a leading cause of pediatric kidney disease.
- PUV management requires careful risk stratification for long-term outcomes like renal replacement therapy (RRT) and bladder dysfunction.
- Previous studies lacked sufficient data for precise risk assessment due to disease rarity.
Purpose of the Study:
- To identify clinical variables predicting the risk of RRT and clean intermittent catheterization (CIC) in children with PUV.
- To establish a risk stratification model for improved patient management and counseling.
Main Methods:
- Retrospective review of 274 children with PUV treated at 5 centers (1995-2005).
- Outcomes assessed: RRT and CIC recommendation.
- Survival analysis used to evaluate predictors and outcomes, focusing on serum nadir creatinine in the first year (SNC1).
Main Results:
- 42 of 274 patients (16%) progressed to RRT by age 10.
- SNC1 was a strong predictor of RRT (log-rank P < .001).
- Estimated 10-year RRT risk varied from 0% (SNC1 <0.4) to 100% (SNC1 ≥1.0 mg/dL). CIC was recommended for 60 patients (26% risk by age 10).
Conclusions:
- Serum nadir creatinine in the first year of life is a critical predictor of RRT in children with PUV.
- Findings enable improved family counseling and targeted screening/intervention for high-risk patients.
- Age at presentation and SNC1 inform prognosis and management strategies for pediatric PUV.
Objectives:
Posterior urethral valves predispose children to renal replacement therapy (RRT) and bladder dysfunction. Researchers of single-institutional series were unable to refine risk stratification because of rarity of the disease. We aimed to identify clinical variables associated with the risk of RRT and clean intermittent catheterization (CIC) in a large multicenter cohort study.
Methods:
Children with posterior urethral valves born between 1995 and 2005 who were treated before 90 days of life at 5 children's hospitals were retrospectively reviewed. Outcomes included RRT and recommendation for CIC. Predictors and outcomes were assessed by using survival analysis.
Results:
A total of 274 patients were managed for a median of 6.3 years, and 42 progressed to RRT. On survival analysis, 16% progressed to RRT by 10 years of age. RRT varied by the serum nadir creatinine level in the first year of life (SNC1) (log-rank P < .001). After stratifying by the SNC1, the estimated risk of progressing to RRT by 10 years of age was 0%, 2%, 27%, and 100% for an SNC1 of <0.4, an SNC1 of 0.4 to 0.69, an SNC1 of 0.7 to 0.99, and an SNC1 of ≥1.0 mg/dL, respectively. CIC was recommended in 60 patients, which translated on survival analysis to a risk of 26% by 10 years of age.
Conclusions:
Risk of RRT and CIC recommendation increased with age. The SNC1 strongly predicted need for RRT. These results allow for both improved family counseling and the potential for more appropriate screening and intervention strategies for those identified in higher-risk groups.
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