Kidney Week

Abstract: SA-PO463

Estimated Glomerular Filtration Rate at Dialysis Initiation and Mortality in Children

Session Information

• Pediatric Nephrology - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yusuke Okuda,

• Soohoo, Melissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Melissa Soohoo,

• Obi, Yoshitsugu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yoshitsugu Obi,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Elani Streja,

• Tang, Ying, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Ying Tang,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Connie Rhee,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

The timing of dialysis initiation and estimated glomerular filtration rate (eGFR) has been hotly debated for adult dialysis patients. However, there are scarce data on the association between eGFR at dialysis initiation and mortality in children.

Methods

In a cohort of incident dialysis patients from 1995-2016 identified from the United States Renal Data System and aged 1–17 years old, we examined the association of eGFR at dialysis initiation with mortality. Mortality risk was estimated using Cox model with three levels of adjustment, i.e., unadjusted, case mix-adjusted, and fully adjusted model including height, body mass index, hemoglobin, and albumin. eGFR was calculated using the pediatric specific bedside Schwartz equation.

Results

Among 10,251 included patients, median age was 13 (IQR: 10–16) years and median eGFR was 7.8 (IQR: 5.7–10.5) mL/min/1.73 m². There appeared a trend toward higher mortality risk across higher eGFR. In particular, eGFR <5 mL/min/1.73 m² was associated with low mortality (fully adjusted hazard ratio [HR], 0.64; 95%CI, 0.50–0.84) (reference: eGFR 5 to <7 mL/min/1.73 m²). This association was consistent in children ≥6 years old, whereas HR was 1.25 (95%CI: 0.67–2.31) for eGFR<5 mL/min/1.73 m² among those <6 years old (reference: eGFR 5 to <7 mL/min/1.73 m²) [Figure].

Conclusion

Low eGFR at dialysis initiation was associated with lower mortality, especially for eGFR levels less than 5 mL/min/1.73 m² in incident dialysis children. The result does not suggest an independent indication of dialysis initiation based on eGFR. If the clinical status allows it, eGFR at dialysis initiation should be considered. Further considerations are needed in children younger than 6 years old.

Funding

• NIDDK Support