Abstract: FR-OR120

suPAR Serum Levels Predict Progression of Kidney Disease in Children

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany
  • Trachtman, Howard, NYU Langone Med Ctr, New York City, New York, United States
  • Kirchner, Marietta, University Heidelberg, Heidelberg, Germany
  • Hayek, Salim, Emory University School of Medicine, Atlanta, Georgia, United States
  • Wei, David Changli, Rush University Medical Center, Chicago, Illinois, United States
  • Sever, Sanja, Massachusetts General Hospital, Charlestown, Massachusetts, United States
  • Smoyer, William E., Nationwide Children's Hospital , Columbus, Ohio, United States
  • Reiser, Jochen, Rush University Medical Center, Chicago, Illinois, United States

Group or Team Name

  • ESCAPE Trial Consortium and the 4C Study Group
Background

Renal disease progression rate in chronic kidney disease (CKD) children is highly variable, and no serum markers exist today that aid with prediction of renal function decline. Even within individual age and disease groups, progression rate varies widely, defining a need for informative prognostic biomarkers predicting disease progression and the need for early intervention in an individual patient. Recently, soluble urokinase receptor (suPAR) has been shown to be a strong predictor of CKD incidence and progression. Here we determine whether elevated suPAR levels are associated with renal disease progression in children with CKD.

Methods

Post-hoc analysis of two prospectively followed pediatric CKD cohorts (ESCAPE trial and 4C Study) including 898 children (mean age 11.9±3.5 years) with serum suPAR level measured at enrollment and longitudinal eGFR measured prospectively. Renal diagnoses included CAKUT (70%), tubulointerstitial nephropathies (10.2%), glomerulopathies (7.7%), post-ischemic (4.7%), and other CKD (6.5%). Mean eGFR was 34±16 ml/min/1.73m2, median follow-up 3.1 (0 to 7.9) years. The primary renal endpoint was a composite of 50% eGFR loss, eGFR<10 ml/min/1.73 m2 or start of renal replacement therapy.

Results

5-year endpoint-free renal survival was 64.5% (95%CI 57.4-71.7%) in children with suPAR in the lowest quartile as compared to 35.9% (95%CI 28.7-43.0%) in those with levels in the highest quartile (P<0.0001). In multivariable analysis, the risk of attaining the endpoint was higher in children with glomerulopathies and increased with age, blood pressure, proteinuria and lower eGFR at baseline. In patients with baseline eGFR>40 ml/min/1.73 m2, higher log-transformed suPAR levels were independently associated with a higher risk of CKD progression (HR 5.12, 95% CI 1.56-16.7, P=0.007).

Conclusion

Elevated suPAR levels are independently associated with disease progression in children with mild to moderate CKD.

Funding

  • NIDDK Support