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Prediction of kidney failure in children with chronic kidney disease and obstructive uropathy
Yuri V Sebastião1, Jennifer N Cooper1,2,3, Brian Becknell4,5
1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
The Kidney Failure Risk Equation (KFRE) shows moderate accuracy in predicting kidney failure in children with obstructive uropathy (OU). Further research is needed to improve prediction models for pediatric kidney disease progression.
Area of Science:
- Pediatric Nephrology
- Urology
- Epidemiology
Background:
- Obstructive uropathy (OU) is a primary cause of kidney injury in children.
- Accurate prediction of kidney disease progression is crucial for improving clinical outcomes in pediatric patients.
- The validated Kidney Failure Risk Equation (KFRE), developed for adults, has not been extensively studied in pediatric populations with OU.
Purpose of the Study:
- To evaluate the discriminative ability and accuracy of the adult-derived KFRE in predicting 5-year kidney failure risk in children with obstructive uropathy.
- To compare the performance of the 4-variable and 8-variable KFRE in this pediatric cohort.
Main Methods:
- A cohort of 118 children with obstructive uropathy and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² was identified from the Chronic Kidney Disease in Children (CKiD) study.
- Baseline data were used to calculate 5-year kidney failure risk using the 4- and 8-variable KFREs.
- Discriminative ability was assessed using the C statistic, with sensitivity and specificity evaluated at various risk thresholds.
Main Results:
- The study included 118 children (85% boys) with a median age of 10 years and median eGFR of 42 mL/min/1.73 m².
- Within a median follow-up of 4.5 years, 19.5% of patients developed kidney failure.
- The 4-variable KFRE demonstrated moderate discrimination (C statistic = 0.75), with a ≥30% risk threshold yielding 82.6% sensitivity and 75.0% specificity; the 8-variable KFRE showed similar performance.
Conclusions:
- The KFRE shows moderate ability to discriminate 5-year kidney failure risk in children with obstructive uropathy, with performance lower than in adults but comparable to other pediatric CKD populations.
- The 8-variable KFRE did not offer improved discrimination or accuracy over the 4-variable version in this cohort.
- Further research is warranted to identify additional, disease-specific markers for enhanced prediction of kidney failure in pediatric obstructive uropathy.
Background:
Obstructive uropathy (OU) is a leading cause of pediatric kidney injury. Accurate prediction of kidney disease progression may improve clinical outcomes. We aimed to examine discrimination and accuracy of a validated kidney failure risk equation (KFRE), previously developed in adults, in children with OU.
Methods:
We identified 118 children with OU and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in the Chronic Kidney Disease in Children study, a national, longitudinal, observational cohort. Each patient's 5-year risk of kidney failure was estimated using baseline data and published parameters for the 4- and 8-variable KFREs. Discriminative ability of the KFRE was estimated using the C statistic for time-to-event analysis. Sensitivity and specificity were evaluated across varying risk thresholds.
Results:
Among the 118 children, 100 (85%) were boys, with median baseline age of 10 years (interquartile range, 6-14). Median eGFR was 42 mL/min/1.73m 2 (32-53), with a median follow-up duration of 4.5 years (2.7-7.2); 23 patients (19.5%) developed kidney failure within 5 years. The 4-variable KFRE discriminated kidney failure risk with a C statistic of 0.75 (95% CI, 0.68-0.82). A 4-variable risk threshold of ≥ 30% yielded 82.6% sensitivity and 75.0% specificity. Results were similar using the 8-variable KFRE.
Conclusions:
In children with OU, the KFRE discriminated the 5-year risk of kidney failure at C statistic values lower than previously published in adults but comparable with suboptimal values reported in the overall CKiD population. The 8-variable equation did not improve model discrimination or accuracy, suggesting the need for continued research into additional, disease-specific markers.
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