BACKGROUND AND OBJECTIVES: The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS: The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001). CONCLUSION: The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
BACKGROUND AND OBJECTIVES: The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS: The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001). CONCLUSION: The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
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Authors: Ellen R Brooks; Shannon Haymond; Alfred Rademaker; Christopher Pierce; Irene Helenowski; Rod Passman; Faye Vicente; Bradley A Warady; Susan L Furth; Craig B Langman Journal: Pediatr Nephrol Date: 2017-12-07 Impact factor: 3.714
Authors: Hanni Menn-Josephy; Carol S Lee; Angela Nolin; Marta Christov; Denis V Rybin; Janice M Weinberg; Joel Henderson; Ramon Bonegio; Andrea Havasi Journal: Am J Nephrol Date: 2016-09-15 Impact factor: 3.754
Authors: Vanessa R Silva; Cristina B Soares; Juliana O Magalhães; Isabella Peixoto de Barcelos; Debora C Cerqueira; Ana Cristina Simões e Silva; Eduardo A Oliveira Journal: ScientificWorldJournal Date: 2015-01-13