Ellen R Brooks1,2, Shannon Haymond3,4, Alfred Rademaker3,5, Christopher Pierce6, Irene Helenowski3,5, Rod Passman3,7, Faye Vicente4, Bradley A Warady8, Susan L Furth9, Craig B Langman3,10. 1. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. e-brooks3@northwestern.edu. 2. Division of Kidney Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Mailstop # 37, 225 E. Chicago Ave, Chicago, IL, 60611, USA. e-brooks3@northwestern.edu. 3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 4. Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 5. Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA. 6. Department of Epidemiology, University Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 7. Division of Cardiology, Department of Internal Medicine, Northwestern Medical Group, Chicago, IL, USA. 8. Division of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, MO, USA. 9. Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 10. Division of Kidney Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Mailstop # 37, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
Abstract
BACKGROUND: In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. METHODS: Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography-tandem mass spectrometry. RESULTS: For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). CONCLUSIONS: In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.
BACKGROUND: In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. METHODS: Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography-tandem mass spectrometry. RESULTS: For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). CONCLUSIONS: In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.
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