Estimating Time to ESRD in Children With CKD

Chronic Kidney Disease in Children (CKiD), Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Rationale & Objective: The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients’ risk for CKD progression. Few data for children informed guideline development. Study Design: Observational cohort study. Settings & Participants: Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Predictor: Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. Outcome: A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR < 15 mL/min/1.73 m2. eGFR was estimated using the CKiD-derived “bedside” equation. Analytical Approach: Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. Results: Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73 m2, 60% were males, and 13% had UPCRs > 2.0 mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90 mL/min/1.73 m2 and UPCRs < 0.5 mg/mg to 0.8 years for eGFRs of 15 to 30 mL/min/1.73 m2 and UPCRs > 2 mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. Limitations: Observational study, used cross-validation rather than external validation. Conclusions: CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.

Original languageEnglish (US)
Pages (from-to)783-792
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume71
Issue number6
DOIs
StatePublished - Jun 1 2018

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Chronic Renal Insufficiency
Chronic Kidney Failure
Glomerular Filtration Rate
Proteinuria
Observational Studies
Creatinine
Cohort Studies
Urine
Guidelines
Renal Replacement Therapy
Kidney Diseases
Disease Progression
Proteins
Pediatrics
Blood Pressure

Keywords

  • children
  • chronic kidney disease (CKD)
  • disease progression
  • disease staging
  • end-stage renal disease (ESRD)
  • estimated glomerular filtration rate (eGFR)
  • Pediatric
  • proteinuria
  • risk pattern
  • urinary protein-creatinine ratio (UPCR)

ASJC Scopus subject areas

  • Nephrology

Cite this

Chronic Kidney Disease in Children (CKiD), & Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators (2018). Estimating Time to ESRD in Children With CKD. American Journal of Kidney Diseases, 71(6), 783-792. https://doi.org/10.1053/j.ajkd.2017.12.011

Estimating Time to ESRD in Children With CKD. / Chronic Kidney Disease in Children (CKiD); Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators.

In: American Journal of Kidney Diseases, Vol. 71, No. 6, 01.06.2018, p. 783-792.

Research output: Contribution to journalArticle

Chronic Kidney Disease in Children (CKiD) & Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators 2018, 'Estimating Time to ESRD in Children With CKD', American Journal of Kidney Diseases, vol. 71, no. 6, pp. 783-792. https://doi.org/10.1053/j.ajkd.2017.12.011
Chronic Kidney Disease in Children (CKiD), Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators. Estimating Time to ESRD in Children With CKD. American Journal of Kidney Diseases. 2018 Jun 1;71(6):783-792. https://doi.org/10.1053/j.ajkd.2017.12.011
Chronic Kidney Disease in Children (CKiD) ; Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators. / Estimating Time to ESRD in Children With CKD. In: American Journal of Kidney Diseases. 2018 ; Vol. 71, No. 6. pp. 783-792.
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abstract = "Rationale & Objective: The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients’ risk for CKD progression. Few data for children informed guideline development. Study Design: Observational cohort study. Settings & Participants: Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Predictor: Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. Outcome: A composite event of renal replacement therapy, 50{\%} reduction in eGFR, or eGFR < 15 mL/min/1.73 m2. eGFR was estimated using the CKiD-derived “bedside” equation. Analytical Approach: Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. Results: Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73 m2, 60{\%} were males, and 13{\%} had UPCRs > 2.0 mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90 mL/min/1.73 m2 and UPCRs < 0.5 mg/mg to 0.8 years for eGFRs of 15 to 30 mL/min/1.73 m2 and UPCRs > 2 mg/mg. Children with glomerular disease were estimated to have a 43{\%} shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. Limitations: Observational study, used cross-validation rather than external validation. Conclusions: CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.",
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TY - JOUR

T1 - Estimating Time to ESRD in Children With CKD

AU - Chronic Kidney Disease in Children (CKiD)

AU - Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Study Investigators

AU - Furth, Susan L.

AU - Pierce, Chris

AU - Hui, Wun Fung

AU - White, Colin A.

AU - Wong, Craig S.

AU - Schaefer, Franz

AU - Wühl, Elke

AU - Abraham, Alison G.

AU - Warady, Bradley A.

AU - Samuels, Joshua

AU - Furth, Susan

AU - Atkinson, Meredith

AU - Wilson, Amy

AU - Quiroga, Alejandro

AU - Massengill, Susan

AU - Selewski, Dave

AU - Ferris, Maria

AU - Kogon, Amy

AU - Kaskel, Frederick

AU - Lande, Marc

AU - Schwartz, George

AU - Saland, Jeffrey

AU - Norwood, Victoria

AU - Matoo, Tej

AU - Hidalgo, Guillermo

AU - Srivaths, Poyyapakkam

AU - Carlson, Joann

AU - Langman, Craig

AU - Mendley, Susan

AU - John, Eunice

AU - Upadhyay, Kiran

AU - Seo-Mayer, Patricia

AU - Patterson, Larry

AU - Parekh, Rulan

AU - Robinson, Lisa

AU - Weinstein, Adam

AU - Samsonov, Dmitry

AU - Kupferman, Juan

AU - Misurac, Jason

AU - Mongia, Anil

AU - Kiessling, Steffan

AU - Sanchez-Kazi, Cheryl

AU - Dart, Allison

AU - Fathallah, Sahar

AU - Claes, Donna

AU - Mitsnefes, Mark

AU - Blydt-Hansen, Tom

AU - Warady, Bradley

AU - Al-Uzri, Amira

AU - Jenkins, Randall

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Rationale & Objective: The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients’ risk for CKD progression. Few data for children informed guideline development. Study Design: Observational cohort study. Settings & Participants: Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Predictor: Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. Outcome: A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR < 15 mL/min/1.73 m2. eGFR was estimated using the CKiD-derived “bedside” equation. Analytical Approach: Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. Results: Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73 m2, 60% were males, and 13% had UPCRs > 2.0 mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90 mL/min/1.73 m2 and UPCRs < 0.5 mg/mg to 0.8 years for eGFRs of 15 to 30 mL/min/1.73 m2 and UPCRs > 2 mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. Limitations: Observational study, used cross-validation rather than external validation. Conclusions: CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.

AB - Rationale & Objective: The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients’ risk for CKD progression. Few data for children informed guideline development. Study Design: Observational cohort study. Settings & Participants: Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Predictor: Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. Outcome: A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR < 15 mL/min/1.73 m2. eGFR was estimated using the CKiD-derived “bedside” equation. Analytical Approach: Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. Results: Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73 m2, 60% were males, and 13% had UPCRs > 2.0 mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90 mL/min/1.73 m2 and UPCRs < 0.5 mg/mg to 0.8 years for eGFRs of 15 to 30 mL/min/1.73 m2 and UPCRs > 2 mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. Limitations: Observational study, used cross-validation rather than external validation. Conclusions: CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.

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KW - chronic kidney disease (CKD)

KW - disease progression

KW - disease staging

KW - end-stage renal disease (ESRD)

KW - estimated glomerular filtration rate (eGFR)

KW - Pediatric

KW - proteinuria

KW - risk pattern

KW - urinary protein-creatinine ratio (UPCR)

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