Identifying children who develop severe chronic kidney disease using primary care records

Area of Science:

• Pediatric Nephrology
• Primary Care Medicine
• Epidemiology

Background:

• Understanding symptom reporting in primary care can facilitate earlier chronic kidney disease (CKD) detection in children.
• Early diagnosis of CKD supports interventions to prevent disease progression and improve long-term outcomes.

Purpose of the Study:

• To determine if symptoms/signs or consultation frequency in primary care predict subsequent pediatric CKD diagnosis.
• To identify specific symptoms and consultation patterns associated with severe CKD in children.

Main Methods:

• A case-control study was conducted using the Clinical Practice Research Datalink.
• Cases were children (<21 years) with incident severe CKD (2000-2018); controls were matched by age, sex, and practice testing rates.
• Conditional logistic regression analyzed symptom predictors and consultation frequency at 24 and 6 months pre-diagnosis.

Main Results:

• Symptoms like growth concerns, edema, and urinary tract infections predicted severe CKD in the 24 months prior.
• Predictive value increased within 6 months, but sensitivity decreased.
• Children with CKD had higher consultation frequencies; combined symptom and frequency data showed modest discrimination (c-statistic 0.70).

Conclusions:

• Despite associations between symptoms, increased consultations, and severe CKD, low positive predictive value complicates early diagnosis.
• The rarity of pediatric CKD presents a diagnostic challenge even with identified predictive factors.