Abstract: TH-PO656

Association between Routine Newborn Metabolic Profiles, CKD, and the Need for Dialysis in Infants and Children

Session Information

  • Pediatric Nephrology
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Developmental Biology and Inherited Kidney Diseases

  • 403 Pediatric Nephrology

Author

  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Group or Team Name

  • Ottawa Newborn Metabolomics Project
Background

Metabolomics offers considerable promise in early disease detection. We set out to test the hypothesis that routine newborn metabolic profiles at birth, obtained as screening for inborn errors of metabolism, would be associated with kidney disease and add incremental information to known clinical risk factors.

Methods

We conducted a population-level cohort study in Ontario, Canada including metabolic profiles from 1, 288, 905 newborns from 2006 to 2015. The primary outcome was CKD or dialysis. Individual metabolites and their ratio combinations were examined in logistic regression models after adjustment for established risk factors for kidney disease and incremental risk prediction measured.

Results

: CKD occurred in 2,086(0.16%, median time 612 days) and dialysis in 641(0.05%, median time 99 days) infants and children. Individual metabolites consisted of amino acids, acyl-carnitines, markers of fatty acid oxidation and others. Base models incorporating clinical risk factors only provided C-statistics of 0.61 for CKD and 0.70 for dialysis. The addition of identified metabolites to the models composed of clinical risk factors resulted in significant incremental improvement in the performance of both models (CKD model: c-statistic 0.66 NRI 0.36 IDI 0.04, dialysis model: c-statistic 0.77 NRI 0.57 IDI 0.09). This was consistent after internal validation using bootstrapping and a sensitivity analysis excluding outcomes within the first 30 days.

Conclusion

Routinely collected screening metabolites at birth are associated with chronic kidney disease and the need for dialytic therapies in infants and children and add incremental information to traditional clinical risk factors.