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Evaluating Kidney Function Decline in Children with Chronic Kidney Disease Using a Multi-Institutional Electronic
Caroline A Gluck1, Christopher B Forrest2,3, Amy Goodwin Davies3
1Division of Pediatric Nephrology, Nemours Children's Health, Wilmington, Delaware.
Clinical Journal of the American Society of Nephrology : CJASN
|February 8, 2023
Summary
In children with chronic kidney disease (CKD), factors like disease cause, proteinuria, hypertension, and younger age predict faster kidney function decline. Understanding these risks aids in managing pediatric CKD progression.
Area of Science:
- Pediatric Nephrology
- Real-world Evidence in Chronic Kidney Disease
- Clinical Epidemiology
Background:
- Chronic kidney disease (CKD) affects children, necessitating identification of progression factors.
- Electronic health records offer a valuable resource for studying pediatric CKD cohorts.
Purpose of the Study:
- To identify a large cohort of children with CKD using US national data.
- To evaluate CKD progression in this cohort.
- To examine clinical risk factors associated with kidney function decline.
Main Methods:
- Retrospective cohort study using PEDSnet data (2009-2022).
- Identified children (18 months-18 years) with CKD based on eGFR criteria.
- Defined CKD progression as a composite outcome including low eGFR, decline, dialysis, or transplant.
- Assessed associations of hypertension, proteinuria, and comorbidities with progression.
Main Results:
- 11,240 children with CKD identified from over 7 million.
- Key predictors of CKD progression included lower eGFR, glomerular disease, malignancy, proteinuria, hypertension, male sex, and younger age.
- Combined proteinuria and hypertension significantly increased progression risk.
Conclusions:
- Disease etiology, albuminuria, hypertension, age, sex, initial eGFR, and medical complexity are linked to faster kidney function decline in pediatric CKD.
- These findings highlight critical factors for monitoring and managing children with CKD.
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