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Kidney Week

Abstract: FR-PO1147

Sex and Glomerular Filtration Rate Trajectories: Insights from the CKiD 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

  • Hogan, Julien, Emory University, Atlanta, Georgia, United States
  • Karadkhele, Geeta, Emory University, Atlanta, Georgia, United States
  • Bonneric, Stéphanie, Hôpital Robert Debré, Paris, France
  • Patzer, Rachel E., Emory University, Atlanta, Georgia, United States
  • Greenbaum, Larry A., Emory University, Atlanta, Georgia, United States
Background

The effect of gender on CKD progression has not been specifically studied in children. Moreover, differences in CKD progression have been hypothesized to partially explain gender disparities in access to transplantation. This study aims to identify distinct trajectories of GFR decline and to investigate the effect of gender on GFR decline.

Methods

The CKiD study is a prospective cohort study that enrolled patients 1–16 yrs with an eGFR of 30–90 mL/minute/1.73 m2. Clinical and laboratory data, including GFR, are collected annually. Latent class mixed model was used to identify GFR trajectories. Multinomial logistic regression was used to study patient characteristics associated with each trajectory.

Results

888 patients were included. Among nonglomerular patients (613), we observed 4 GFR trajectories: 35 with median baseline GFR/no decline; 327 with high baseline GFR/slow decline; 231 with low baseline GFR/slow decline and 20 with high baseline GFR/rapid decline (Figure 1, class 1 to 4 respectively). Known risk factors of progression differed between trajectories. The proportion of girls was higher in the group with stable GFR (57%) than in other groups (32-35%). Patients with stable GFR had lower prevalence of acidosis, anemia and proteinuria. Female gender remained associated with the absence of progression (OR 2.7 [1.3-5.5]) after adjusting for other risk factors. This effect remained after stratification on pubertal status. Among glomerular patients (275), progression was mostly related to the underlying glomerulopathy.

Conclusion

The slower progression in girls is driven by a subgroup with nonglomerular diseases and stable GFR. The effect of gender seems independent of pubertal status, arguing against a direct effect of sex hormone to explain gender disparity in CKD progression.