Kidney Week

Abstract: PUB218

eGFR Trajectory Patterns Among Children Aged 2-8 Years with Indication of CKD: An Analysis of National Laboratory Data

Session Information

• Publication Only

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham, MS, PhD

• Licon, Ana Laura, University of Michigan Medical School, Ann Arbor, Michigan, United States

Ana Laura Licon, MS

• Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States

Rajiv Saran, MD, MBBS, MS

• Modi, Zubin J., University of Michigan Medical School, Ann Arbor, Michigan, United States

Zubin J. Modi, MD, MS

Background

Chronic kidney disease (CKD) is rare in children and understudied, which limits evidence to aid in care for these patients. Also, pediatric chronic kidney disease (CKD) progression is highly variable, with roughly 38% of children showing progression within 2 years (>50% decline in estimated glomerular filtration rate [eGFR] or reaching kidney failure [ESRD]). Using national laboratory data from Labcorp, we sought to determine patters of eGFR decline among children with diagnosed CKD.

Methods

A cohort of 1,720 children, aged 2 to 8 years, with an ICD-9 indication of CKD on any lab requisition forms during 2013 were follow-up through 2018 to examine change in eGFR over time. GFR was estimated using the serum creatinine based U25 equation, developed for pediatric use, using imputed height (50^th percentile based on age). Age and sex of each child was available, and the comorbid conditions of diabetes, hypertension, and anemia were created from ICD codes. GFR trajectories were examined among children with at least three labs over time, using linear regression.

Results

The average age of the cohort was 5.5 years (SD=1.7 years), with 73.8% males, 3.2% having diabetes, 7.0% with hypertension, and 19.9% with anemia. The average decline in eGFR was 2 ml/min/1.73m2 per year overall, but may be an overestimate due to sicker patients having more laboratory measures available. Future work will include follow-up to 10 years and examine demograhics and comorbidities as predictors of decline. We will also assess the time to a 50% decline in eGFR.

Conclusion

Having a better understanding of eGFR trajectories in pediatric patients should aid clinicians in caring for this population. It is important for delaying end-stage renal disease (ESRD), managing growth, optimizing nutritional intake, and minimizing complications like bone disease and cardiovascular damage. By identifying early progression patients can receive timely therapeutic interventions to not only delay progression, but also improve the quality of life of pediatric kidney patients.

Funding

• Other U.S. Government Support