Abstract: FR-PO0734
Accelerated GFR Decline at Time of Transition to Adult Care Is Preceded by Increases in Proteinuria and Risk of Hypertension in Pediatric CKD
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Ng, Derek K., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Levy, Rebecca V., University of Rochester Medical Center, Rochester, New York, United States
- Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
- Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Group or Team Name
- CKiD Study Investigators.
Background
Transition to adult care in pediatric chronic kidney disease (CKD) is a critical phase of clinical care and presents challenges for cardiovascular disease (CVD) and CKD management. We investigated longitudinal proteinuria, hypertension and GFR decline among participants in the Chronic Kidney Disease in Children (CKiD) study who reached age 18 years free of kidney replacement therapy (KRT).
Methods
Using longitudinal data on proteinuria, hypertension and U25eGFR with age as the timescale, and stratified by glomerular/nonglomerular diagnoses, penalized likelihood methods identified the age at an optimal linear spline. AIC quantified training error for separate models with a knot at 0.25 year intervals from ages 14-22. Linear mixed effects models were used for proteinuria and GFR; repeated measures logistic model was used for hypertension.
Results
Among 247 children with nonglomerular CKD (2142 observations), GFR declined after age 15.5 (-4.7% vs. -1.5% per year, p< 0.001). Among 96 children with glomerular CKD (596 observations), GFR declined after age 18 (-10.6% vs. 2.6%/year, p< 0.001). Proteinuria increased at age 11 for those with nonglomerular (-2.9% vs. +15.8%/year, p< 0.001), and proteinuria linearly increased by 6.4% per year among those with glomerular diagnoses. For nonglomerular CKD, hypertension risk increased at age 11.5 (7%/year, p<0.001); and at age 14 for those with glomerular CKD, hypertension risk increased 18% per year (p<0.001).
Conclusion
For CKiD participants free of KRT at age 18, GFR decline accelerated around age 15.5 and 18 for those with nonglomerular and glomerular CKD, respectively. Adult care providers can expect to manage GFR decline after transition to adult care. Enhanced strategies to manage proteinuria and hypertension at younger ages may improve outcomes.
GFR decline for CKD diagnoses based on a mixed model with a optimized linear spline.
Funding
- NIDDK Support