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Abstract: PO2302

Urine Biomarkers of CKD Progression in Children

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Greenberg, Jason Henry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Abraham, Alison G., Johns Hopkins University, Baltimore, Maryland, United States
  • Xu, Yunwen, Johns Hopkins University, Baltimore, Maryland, United States
  • Schelling, Jeffrey R., Case Western Reserve University, Cleveland, Ohio, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Sabbisetti, Venkata, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Ix, Joachim H., University of San Diego, San Diego, California, United States
  • Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Denburg, Michelle, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Furth, Susan L., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Group or Team Name

  • CKD Biomarker Consortium
Background

Biomarkers of tubular injury, repair, and inflammation may improve the ability to identify children at high risk of rapid kidney function decline and help elucidate the pathophysiology of CKD progression. In this study, we investigated whether the urinary biomarkers EGF, KIM1, MCP1, YKL40, and alpha1 microglobulin are prognostic of CKD progression in children.

Methods

In the prospective CKiD study, children aged 6 months to 16 years old with an eGFR of 30-90 were enrolled and eGFR was assessed annually. We measured urine biomarkers collected 5 months after study enrollment. Urine biomarkers were indexed to urine creatinine. The primary outcome was CKD progression, defined as a composite of a 50% decline in eGFR or ESKD.

Results

Of the 375 children included, median age was 12 years [IQR, 8-15], 227 (61%) were male, and baseline eGFR was 44 [IQR, 35-56]. Overall, 187 children (50%) reached the primary outcome over a median follow-up time of 6.2 years [IQR, 3.0–10.3]. All biomarker levels were higher in children with CKD progression, except for EGF which was lower in those with CKD progression (p for all <0.05). After adjustment for confounders, children with urine EGF concentrations in the highest quartile were at a significantly lower risk of CKD progression compared to those with EGF in the lowest quartile [EGF aHR; 0.20 (95% CI: 0.11-0.39)] (Table). Children with urine KIM1 and MCP1 in the highest quartile were at a significantly higher risk of CKD progression compared to those in the lowest quartile [KIM1 aHR; 2.6 (95% CI: 1.6-4.1), MCP1 aHR; 2.8 (95% CI: 1.7-4.7)].

Conclusion

Low urine EGF and elevated urine KIM1 and MCP1 concentrations are independently associated with CKD progression in children.

Funding

  • NIDDK Support