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Published on: June 16, 2014
Urologic care and progression to end-stage kidney disease: a Chronic Kidney Disease in Children (CKiD) nested
D I Chu1, A G Abraham2, G E Tasian3
1Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Urologic care, especially with surgery, may lower the risk of end-stage kidney disease (ESKD) in children with chronic kidney disease (CKD). However, the benefit depends on the specific underlying diagnosis, highlighting the importance of tailored treatment approaches.
Area of Science:
- Pediatric Nephrology
- Urology
- Chronic Kidney Disease Research
Background:
- Children with chronic kidney disease (CKD) face a significant risk of progressing to end-stage kidney disease (ESKD).
- Congenital anomalies of the kidney and urinary tract are primary causes of pediatric CKD and often require urologic intervention.
Purpose of the Study:
- To investigate the relationship between urologic care and the incidence of ESKD in pediatric CKD patients.
- To determine if urologic referral and surgical intervention impact ESKD risk in children with non-glomerular CKD.
Main Methods:
- A nested case-control study was conducted within the Chronic Kidney Disease in Children (CKiD) cohort.
- Children aged 1-16 with non-glomerular CKD were analyzed, focusing on prior urologic referral with or without surgery.
- Conditional logistic regression was used to estimate the rate ratios (RRs) for ESKD incidence.
Main Results:
- Urologic care was provided to 70% of the study cohort, with nearly all cases of obstructive uropathy and reflux nephropathy receiving it.
- Children who underwent urologic referral with surgery had a 50% lower risk of ESKD compared to those without prior urologic care.
- This association was attenuated when diagnoses highly correlated with urologic surgery were excluded, suggesting a role for specific conditions.
Conclusions:
- Urologic care is frequently administered to children with non-glomerular CKD, but not universally.
- Urologic surgery demonstrated a reduced risk of ESKD in this population, though the effect is diagnosis-dependent.
- Specific underlying diagnoses significantly influence both ESKD risk and the potential benefits of urologic interventions.
Introduction:
Children with chronic kidney disease (CKD) risk progressing to end-stage kidney disease (ESKD). The majority of CKD causes in children are related to congenital anomalies of the kidney and urinary tract, which may be treated by urologic care.
Objective:
To examine the association of ESKD with urologic care in children with CKD.
Study Design:
This was a nested case-control study within the Chronic Kidney Disease in Children (CKiD) prospective cohort study that included children aged 1-16 years with non-glomerular causes of CKD. The primary exposure was prior urologic referral with or without surgical intervention. Incidence density sampling matched each case of ESKD to up to three controls on duration of time from CKD onset, sex, race, age at baseline visit, and history of low birth weight. Conditional logistic regression analysis was performed to estimate rate ratios (RRs) for the incidence of ESKD.
Results:
Sixty-six cases of ESKD were matched to 153 controls. Median age at baseline study visit was 12 years; 67% were male, and 7% were black. Median follow-up time from CKD onset was 14.9 years. Seventy percent received urologic care, including 100% of obstructive uropathy and 96% of reflux nephropathy diagnoses. Cases had worse renal function at their baseline visit and were less likely to have received prior urologic care. After adjusting for income, education, and insurance status, urology referral with surgery was associated with 50% lower risk of ESKD (RR 0.50 [95% confidence interval [CI] 0.26-0.997), compared to no prior urologic care (Figure). After excluding obstructive uropathy and reflux nephropathy diagnoses, which were highly correlated with urologic surgery, the association was attenuated (RR 0.72, 95% CI 0.24-2.18).
Discussion:
In this study, urologic care was commonly but not uniformly provided to children with non-glomerular causes of CKD. Underlying specific diagnoses play an important role in both the risk of ESKD and potential benefits of urologic surgery.
Conclusion:
Within the CKiD cohort, children with non-glomerular causes of CKD often received urologic care. Urology referral with surgery was associated with lower risk of ESKD compared to no prior urologic care but depended on specific underlying diagnoses.
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