Abstract: SA-PO371
Follow-Up of Low Estimated Glomerular Filtration Rate (eGFR) in Children in the US Military Health System (MHS)
Session Information
- Pediatric Nephrology - III
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Oliver, James D., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
- Gorman, Gregory H., Defense Health Agency, Falls Church, Virginia, United States
- Nee, Robert, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
- Mendley, Susan R., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
- Marneweck, Hava, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
- Banaag, Amanda, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
- Koyama, Alain K., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Miyamoto, Yoshihisa, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Xu, Fang, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Background
For children, calculation of eGFR from serum creatinine (sCr) is typically not available in the electronic record and clinicians may fail to recognize an abnormal eGFR in the absence of previously known kidney disease. We retrospectively analyzed the extent of this issue in a large diverse pediatric population using the MHS Data Repository.
Methods
We extracted data for 1,561,622 children ages 1–17 enrolled in the MHS from 2016-2019, using the CKiD U-25 equation to calculate eGFR. Low eGFR was defined as the first occurrence of either <75 or <60 mL/min/1.73m2. Follow-up was defined as a repeat sCr ≤90 days after the low eGFR. Children with > 8 sCr measurements or with the first low eGFR obtained ≤90 days from the end of 2019 without follow-up were excluded from analysis.
Results
sCr was measured in 128,033 (8.2%) of children. After exclusions there was at least one eGFR <75 and one <60 mL/min/1.73m2 in 15,395 (12.0%) and 3168 (2.5%) children, respectively (Table). Follow-up sCr ≤90 days after low eGFR was performed infrequently; it was obtained in 9.7% vs 12.4% of children with eGFR <75 vs. <60 mL/min/1.73m2, respectively. First follow-up sCr at >90 days were obtained in 13.2% vs.11.6% of children, and no follow-up labs were obtained in 77.1% vs. 76.1%. For eGFR <75 mL/min/1.73m2, absence of follow-up labs within 90 days was associated with female sex (odds ratio [OR], 95% confidence interval [CI]=1.2, 1.1–1.3), ages 5–9 vs. 1–4 (OR, 95%CI=1.2, 1.03–1.4), ages 10–13 vs. 1–4 (OR, 95%CI=1.3, 1.1–1.6), and Black vs. White race (OR, 95%CI=1.2, 1.1–1.4). Sex, age, and race were not associated with lack of follow-up labs for GFR <60 mL/min/1.73m2.
Conclusion
In the MHS, follow-up measurements of decreased eGFR in children were infrequent, suggesting a gap in recognition of reduced kidney function and a potential area for improvement.
The views expressed in this abstract are those of the authors and do not reflect the official position of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, the Department of Health and Human Services, or the US Government.
Funding
- Other U.S. Government Support