ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-OR43

Using Electronic Health Record(EHR) Data to Evaluate Kidney Function Decline in Children with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Gluck, Caroline A., Alfred I DuPont Hospital for Children, Wilmington, Delaware, United States
  • Goodwin Davies, Amy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Mcdonald, Jill R., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Maltenfort, Mitchell, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States
  • Dixon, Bradley P., University of Colorado, Denver, Colorado, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Neu, Alicia, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Hovinga, Collin A., Institute for Advanced Clinical Trials for Children, Rockville, Maryland, United States
  • Skversky, Amy L., Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Eissing, Thomas, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Kaiser, Andreas, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Breitenstein, Stefanie, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Forrest, Christopher B., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Background

This study utilized EHR data from pediatric centers to identify children with CKD and examine risk factors for kidney function decline.

Methods

We used PEDSnet, a network with EHR data from >7million children in 7 health systems, to identify children aged 1-18 yrs between 2009-2020 who met CKD criteria: two eGFR<90 mL/min/1.73m2 separated by ≥90 days without an intervening higher value. CKD progression was defined as composite outcome: eGFR<15 mL/min/1.73m2, 50% eGFR decline, chronic dialysis, or kidney transplant. Subcohorts were based on CKD etiology: glomerular, non-glomerular or malignancy. We assessed impact of hypertension(HTN) (≥2visits with HTN code) and proteinuria (≥1 lab value ≥1+) within 2yrs of cohort entrance on outcomes.

Results

We identified 7395 children, median age 14.1yrs, 36% females, 23% blacks, median follow-up 4.2yrs. Median initial eGFR was 75.5 ml/min/1.73m2; 36% had proteinuria; 46 % had HTN. Children with glomerular CKD were more likely to reach outcomes (p<0.001). Children with HTN, proteinuria, or both were more likely to reach outcomes(p<0.001).

Conclusion

The EHR may be used to study large numbers of children with CKD. Risk factors for CKD progression were glomerular disease, HTN and proteinuria.

Endpoint reached by sub-cohort
 Non-Glomerular (N=5739)Glomerular (N=1091)
Malignancy (N=565)
Overall (N=7395)
Any844 (14.7%)491 (45.0%)154 (27.3%)1,489 (20.1%)
eGFR halved727 (12.7%)424 (38.9%)142 (25.1%)1,293 (17.5%)
eGFR<15504 (8.8%)359 (32.9%)91 (16.1%)954 (12.9%)
Kidney transplant192 (3.3%)132 (12.1%)28 (5.0%)352 (4.8%)
Chronic dialysis64 (1.1%)90 (8.2%)15 (2.7%)169 (2.3%)

Funding

  • Other U.S. Government Support