Kidney Week

Abstract: FR-PO1166

Common Clinical Markers Predict ESRD in Children with Obstructive Uropathy

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

• Mcleod, Daryl J., Nationwide Children's Hospital, Columbus, Ohio, United States

Daryl J. Mcleod,

• Ching, Christina B., Nationwide Children's Hospital, Columbus, Ohio, United States

Christina B. Ching,

• Sebastião, Yuri Vanda, Nationwide Children's Hospital, Columbus, Ohio, United States

Yuri Vanda Sebastião,

• McHugh, Kirk M., Nationwide Children's Hospital, Columbus, Ohio, United States

Kirk M. McHugh,

• Becknell, Brian, Nationwide Children's Hospital, Columbus, Ohio, United States

Brian Becknell,

Background

Obstructive uropathy (OU) is the leading cause of pediatric chronic kidney disease (CKD) and end stage renal disease (ESRD). Children who escape the newborn period with mild to moderate CKD continue to be at increased risk for progression, especially as they undergo pubertal changes. The predictive ability of clinical markers throughout childhood is poorly defined in OU.

Methods

Patients with OU were identified in the Chronic Kidney Disease in Children Study (CKiD), a prospective observational cohort of children with mild to moderate CKD. The primary outcome of interest was ESRD (Cases). OU patients who did not progress to ESRD during follow-up (Controls) were age matched to Cases. Glomerular Filtration Rate (GFR), urine (protein/Cr and microalbumin/Cr), and serum (CO₂, phosphate, albumin, and hemoglobin), were evaluated as predictor variables both at baseline and over time.

Results

Median age at baseline and outcome was 10 vs.16 years(y) respectively. Cases (n=27) and Controls (n=41) had significant differences in baseline GFR (36.9 vs. 53.5 ml/min/1.73m²), urine protein/Cr (0.40 vs. 0.22) and microalbumin/Cr (0.58 vs. 0.03), and serum C0₂ (20 vs. 22 mmol/L) and hemoglobin (12.4 vs. 13.2 g/dL) respectively. GFR declined 3.07 ml/min/1.73m²/y faster in Cases (p<.0001) (Figure). Urine protein/Cr and microalbumin/Cr declined 0.16/y and 0.11/y faster in Cases respectively (p≤0.001 for both). Serum phosphate increased 0.11 mg/dL/y and albumin and hemoglobin decreased 0.04 g/dL/y and 0.14 g/dL/y faster for Cases respectively (p<0.05 for all).

Conclusion

Baseline and longitudinal evaluation of clinical measures predicts ESRD in children with mild to moderate CKD from OU. Optimal cutoff values require further evaluation so that children identified at high risk can undergo closer surveillance that may allow changes in management to slow or halt progression.

Figure. Estimated change in GFR over time in the CKiD OU cohort