Yuri V Sebastião1, Jennifer N Cooper1,2,3, Brian Becknell4,5, Christina B Ching4,6, Daryl J McLeod7,8. 1. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 2. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. 3. Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA. 4. Center For Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 5. Department of Pediatrics, Section of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA. 6. Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA. 7. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. Daryl.mcleod@nationwidechildrens.org. 8. Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA. Daryl.mcleod@nationwidechildrens.org.
Abstract
BACKGROUND: Obstructive uropathy (OU) is a leading cause of pediatric kidney injury. Accurate prediction of kidney disease progression may improve clinical outcomes. We aimed to examine discrimination and accuracy of a validated kidney failure risk equation (KFRE), previously developed in adults, in children with OU. METHODS: We identified 118 children with OU and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in the Chronic Kidney Disease in Children study, a national, longitudinal, observational cohort. Each patient's 5-year risk of kidney failure was estimated using baseline data and published parameters for the 4- and 8-variable KFREs. Discriminative ability of the KFRE was estimated using the C statistic for time-to-event analysis. Sensitivity and specificity were evaluated across varying risk thresholds. RESULTS: Among the 118 children, 100 (85%) were boys, with median baseline age of 10 years (interquartile range, 6-14). Median eGFR was 42 mL/min/1.73m 2 (32-53), with a median follow-up duration of 4.5 years (2.7-7.2); 23 patients (19.5%) developed kidney failure within 5 years. The 4-variable KFRE discriminated kidney failure risk with a C statistic of 0.75 (95% CI, 0.68-0.82). A 4-variable risk threshold of ≥ 30% yielded 82.6% sensitivity and 75.0% specificity. Results were similar using the 8-variable KFRE. CONCLUSIONS: In children with OU, the KFRE discriminated the 5-year risk of kidney failure at C statistic values lower than previously published in adults but comparable with suboptimal values reported in the overall CKiD population. The 8-variable equation did not improve model discrimination or accuracy, suggesting the need for continued research into additional, disease-specific markers.
BACKGROUND: Obstructive uropathy (OU) is a leading cause of pediatric kidney injury. Accurate prediction of kidney disease progression may improve clinical outcomes. We aimed to examine discrimination and accuracy of a validated kidney failure risk equation (KFRE), previously developed in adults, in children with OU. METHODS: We identified 118 children with OU and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in the Chronic Kidney Disease in Children study, a national, longitudinal, observational cohort. Each patient's 5-year risk of kidney failure was estimated using baseline data and published parameters for the 4- and 8-variable KFREs. Discriminative ability of the KFRE was estimated using the C statistic for time-to-event analysis. Sensitivity and specificity were evaluated across varying risk thresholds. RESULTS: Among the 118 children, 100 (85%) were boys, with median baseline age of 10 years (interquartile range, 6-14). Median eGFR was 42 mL/min/1.73m 2 (32-53), with a median follow-up duration of 4.5 years (2.7-7.2); 23 patients (19.5%) developed kidney failure within 5 years. The 4-variable KFRE discriminated kidney failure risk with a C statistic of 0.75 (95% CI, 0.68-0.82). A 4-variable risk threshold of ≥ 30% yielded 82.6% sensitivity and 75.0% specificity. Results were similar using the 8-variable KFRE. CONCLUSIONS: In children with OU, the KFRE discriminated the 5-year risk of kidney failure at C statistic values lower than previously published in adults but comparable with suboptimal values reported in the overall CKiD population. The 8-variable equation did not improve model discrimination or accuracy, suggesting the need for continued research into additional, disease-specific markers.
Authors: Susan L Furth; Chris Pierce; Wun Fung Hui; Colin A White; Craig S Wong; Franz Schaefer; Elke Wühl; Alison G Abraham; Bradley A Warady Journal: Am J Kidney Dis Date: 2018-04-10 Impact factor: 8.860
Authors: Bradley A Warady; Alison G Abraham; George J Schwartz; Craig S Wong; Alvaro Muñoz; Aisha Betoko; Mark Mitsnefes; Frederick Kaskel; Larry A Greenbaum; Robert H Mak; Joseph Flynn; Marva M Moxey-Mims; Susan Furth Journal: Am J Kidney Dis Date: 2015-03-19 Impact factor: 8.860
Authors: J Malyszko; J S Malyszko; H Bachorzewska-Gajewska; B Poniatowski; S Dobrzycki; M Mysliwiec Journal: Transplant Proc Date: 2009 Jan-Feb Impact factor: 1.066