Abstract: FR-PO1165
Incidence and Long-Term Outcomes of Neonatal Renal Vein Thrombosis in Ontario: A Population-Based Cohort Study
Session Information
- Pediatric Nephrology - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1600 Pediatric Nephrology
Authors
- Ouellette, Allison C., McMaster University, Hamilton, Ontario, Canada
- Darling, Liz, McMaster University, Hamilton, Ontario, Canada
- Babe, Glenda, Institute for Clinical and Evaluative Sciences, Hamilton, Ontario, Canada
- Perez, Richard, ICES, Hamilton, Cabo Verde
- Chan, Anthony K c, McMaster University, Hamilton, Ontario, Canada
- Chanchlani, Rahul, McMaster University, Hamilton, Ontario, Canada
Background
There is limited data at a population level on the burden and long-term outcomes of neonatal renal vein thrombosis (nRVT). We conducted a cohort study to determine the incidence and long-term outcomes including hypertension (HTN), chronic kidney disease (CKD), end-stage renal disease (ESRD) and mortality associated with nRVT during a period of 24 years.
Methods
Health administrative databases, housed at the Institute for Clinical Evaluative Sciences, were used to identify all neonates ≤28 days of age born in Ontario, Canada from 1992-2016 and compared all neonates with nRVT vs. the total neonatal population without nRVT. The primary outcome was the composite risk of long-term outcomes including CKD, ESRD (chronic dialysis or kidney transplant) and all-cause mortality. The secondary outcome was the long-term risk of HTN. Incidence rates (IR) were calculated and Cox proportional hazard models were fitted for all outcomes.
Results
The annual IR of nRVT in Ontario from 1992-2016 was 2.6 per 100,000 live births (total 85 cases from 3,001,637 live births). The median follow-up was 11 years in both cohorts. There was a male preponderance (64%) of nRVT. A greater proportion of nRVT vs. comparator cohort was premature (45% vs. 8%, Standardized Difference 0.92). After adjusting for confounders, patients with nRVT were at a 17-fold increased risk of CKD or death (Hazard Ratio (HR) 16.9, 95% CI 12.3-23.2, p<.0001) and an 18-fold increased risk of HTN (HR 17.7, 95% CI 12.6-25.0, p<.0001) vs. the comparator cohort. None of the nRVT cohort developed ESRD.
Conclusion
Patients with nRVT remain at higher risk than the general neonatal population of long-tern morbidity and mortality, indicating the need for long-term follow-up.
Table 1: Incident rates and hazard ratios of adverse outcomes among patients with nRVT in Ontario from 1992-2016
| Outcomes | Proportion of live births with outcome | Risk of adverse outcomes | |||||
| nRVT Cohort n=85 | Comparator Cohort n=3,001,552 | Unadjusted HR | 95% CI† | Adjusted HR* | 95% CI† | ||
| Primary Outcome | CKD or Death | 43% | 0.7% | 67.6 | 49.4 - 92.5 | 16.9 | 12.3 - 23.2 |
| Secondary Outcome | HTN | 39% | 2% | 30.0 | 21.3 - 42.2 | 17.7 | 12.6 - 25.0 |
† All outcomes were significant with p<0.0001 *Adjusted for sex, congenital heart disease, respiratory distress syndrome, sepsis, maternal preeclampsia or eclampsia, and maternal diabetes. CKD, chronic kidney disease; HTN, hypertension; HR, hazard ratio; CI, confidence interval.