Kidney Week

Abstract: SA-PO361

Neonatal Risk Factors for CKD Progression in Children

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

• Sims, Joya M., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Joya M. Sims,

• Matheson, Matthew, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Matthew Matheson,

• Ng, Derek K., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Derek K. Ng,

• Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Bradley A. Warady,

• Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth,

• Hartung, Erum Aftab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Erum Aftab Hartung,

Group or Team Name

• CKiD Study Investigators.

Background

Neonatal risk factors for childhood CKD include prematurity, acute kidney injury (AKI), and sepsis. It is not known how these factors, assessed in the 1^st 90 days of life, are associated with early childhood kidney function in children with congenital kidney diseases.

Methods

Neonatal data including gestational age (GA); AKI or sepsis in first 90 days; and serum creatinine (SCr) at discharge was retrospectively collected on Chronic Kidney Disease in Children (CKiD) cohort study participants with congenital anomalies of the kidneys and urinary tract and other congenital kidney diseases. Participants with ≥1 CKiD study eGFR in follow up were included. SCr at NICU discharge was indexed to published mean SCr for GA and postnatal age (PMID: 34142253). We assessed univariate relationships between each predictor and incidence of eGFR<30 mL/min/1.73m² by age 5 years (eGFR<30_5y) and parametric survival for time to eGFR<30 mL/min/1.73m² (eGFR<30).

Results

123 children (71% male; median [IQR] baseline age 3.0 [1.7, 4.3] y) had available neonatal data. 36% were premature (GA<37 weeks). Median [IQR] birth weight was 3.13 [2.60, 3.46] kg; discharge age was 21 [7, 40] days;median discharge SCr was 1.00 [0.65, 1.55] mg/dL; discharge SCr index was 3.3 [2.0, 4.5]. 40% had history of AKI; 13% had history of sepsis. Prematurity, AKI, and sepsis were not associated with risk of eGFR<30_5y. SCr index >3.5 at discharge was associated with 52% earlier time to eGFR<30. Cumulative incidence of eGFR<30_5y was 21% for participants with discharge SCr index ≤3.5 and 47% for those with discharge SCr index >3.5 (Figure 1).

Conclusion

SCr index >3.5 by 90 days of age was associated with a significantly higher risk of eGFR <30 mL/min/1.73m² by age 5 years in children with congenital kidney diseases in the CKiD cohort. Prematurity, AKI, and sepsis were not associated with CKD progression risk in this cohort.

Funding

• NIDDK Support