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Abstract: SA-OR44

Puberty Is Associated with Decline in Estimated Glomerular Filtration Rate in Children with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Kim, Hannah, Johns Hopkins University, Baltimore, Maryland, United States
  • Ng, Derek, Johns Hopkins University, Baltimore, Maryland, United States
  • Matheson, Matthew, Johns Hopkins University, Baltimore, Maryland, United States
  • Atkinson, Meredith A., Johns Hopkins University, Baltimore, Maryland, United States
  • Akhtar, Yasmin, Johns Hopkins University, Baltimore, Maryland, United States
  • Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Ruebner, Rebecca, Johns Hopkins University, Baltimore, Maryland, United States
Background

Puberty is a high-risk period for decline in kidney function among children with CKD. We aimed to describe changes in eGFR before and after pubertal onset using different objective markers of puberty among children with CKD.

Methods

We conducted a prospective cohort study using data from the Chronic Kidney Disease in Children (CKiD) study. Children who had onset of CKD after pubertal onset were excluded. GFR was estimated annually using the bedside and complete CKiD equations. Pubertal onset was defined by three separate definitions: transition to Tanner Stage 2, peak growth velocity, and menarche. A mixed effects model with random intercept and random slope was used to compare the slope of eGFR before and after pubertal onset. The model was adjusted for age, race, glomerular diagnosis, baseline proteinuria, and BMI.

Results

339 girls and 552 boys were included; Median age of pubertal onset for girls was 11.0 years (IQR 9.8, 12.1), 14.1 years (IQR 12.4, 17.0), and 14.4 years (IQR 13.1, 15.7) as defined by Tanner stage 2, peak growth velocity, and menarche, respectively. Median age of pubertal onset for boys was 12.4 years (11.3, 13.3) and 14.6 years (IQR 13.4, 16.6) as defined by Tanner stage 2 and peak growth velocity, respectively. Annual percent change in eGFR declined faster among girls and boys after pubertal onset when defined by all measures, after adjustment. For example, annual percent decrease in eGFR was seen to increase from 2.6% prior to 9.0% after Tanner stage 2 in boys using the complete CKiD equation (p<0.001).

Conclusion

Estimated GFR declined faster after the onset of puberty among girls and boys with CKD. Clinicians should be aware that puberty may be an important time of kidney function decline among children with CKD.

Funding

  • NIDDK Support