Yunwen Xu1, Derek K Ng1, Susan L Furth2, Bradley A Warady3, Mark M Mitsnefes4. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA. 4. Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC: 7022, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. mark.mitsnefes@cchmc.org.
Abstract
BACKGROUND: Chronic kidney disease (CKD) is associated with many comorbidities requiring complex management. We described treatment patterns for common modifiable CKD complications (high blood pressure, anemia, hyperphosphatemia, and acidosis) according to severity of CKD and examined factors associated with the absence of drug therapy, among participants with a persistent comorbidity, for 1 year in children enrolled in the CKiD study. METHODS: A total of 703 CKiD participants contributed 2849 person-visits over a median 3.5 years of follow-up. Using pairs of annual visits, we examined whether participants with abnormal biomarker levels at the first (index) visit persisted in the abnormal levels 1 year later according to CKD risk stage. Multivariate analyses identified demographic and clinical factors associated with the absence of drug therapy among those with persistent comorbid conditions for 1 year. RESULTS: The overall proportions of person-visits prescribing therapy at 1-year follow-up for treating anemia, acidosis, hyperphosphatemia, and high blood pressure were 54%, 45%, 29%, and 81%, respectively. The frequency of therapy increased with advanced CKD risk stage for all comorbidities; however, 19-23% of participants with acidosis, 24-27% with anemia, and 30-39% with hyperphosphatemia at high-risk stages (E and F) were not prescribed appropriate therapy despite the persistence of abnormal levels of these biomarkers for at least 1 year. The resolution of comorbidities at advanced CKD stages without treatment was unlikely. CONCLUSIONS: Many children with CKD in the CKiD cohort did not receive pharmacological treatment for common and persistent modifiable comorbidities, even in severe CKD risk stages.
BACKGROUND: Chronic kidney disease (CKD) is associated with many comorbidities requiring complex management. We described treatment patterns for common modifiable CKD complications (high blood pressure, anemia, hyperphosphatemia, and acidosis) according to severity of CKD and examined factors associated with the absence of drug therapy, among participants with a persistent comorbidity, for 1 year in children enrolled in the CKiD study. METHODS: A total of 703 CKiD participants contributed 2849 person-visits over a median 3.5 years of follow-up. Using pairs of annual visits, we examined whether participants with abnormal biomarker levels at the first (index) visit persisted in the abnormal levels 1 year later according to CKD risk stage. Multivariate analyses identified demographic and clinical factors associated with the absence of drug therapy among those with persistent comorbid conditions for 1 year. RESULTS: The overall proportions of person-visits prescribing therapy at 1-year follow-up for treating anemia, acidosis, hyperphosphatemia, and high blood pressure were 54%, 45%, 29%, and 81%, respectively. The frequency of therapy increased with advanced CKD risk stage for all comorbidities; however, 19-23% of participants with acidosis, 24-27% with anemia, and 30-39% with hyperphosphatemia at high-risk stages (E and F) were not prescribed appropriate therapy despite the persistence of abnormal levels of these biomarkers for at least 1 year. The resolution of comorbidities at advanced CKD stages without treatment was unlikely. CONCLUSIONS: Many children with CKD in the CKiD cohort did not receive pharmacological treatment for common and persistent modifiable comorbidities, even in severe CKD risk stages.
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Authors: Denver D Brown; Jennifer Roem; Derek K Ng; Kimberly J Reidy; Juhi Kumar; Matthew K Abramowitz; Robert H Mak; Susan L Furth; George J Schwartz; Bradley A Warady; Frederick J Kaskel; Michal L Melamed Journal: Clin J Am Soc Nephrol Date: 2020-05-28 Impact factor: 8.237
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Authors: George J Schwartz; Michael F Schneider; Paula S Maier; Marva Moxey-Mims; Vikas R Dharnidharka; Bradley A Warady; Susan L Furth; Alvaro Muñoz Journal: Kidney Int Date: 2012-08 Impact factor: 10.612
Authors: Katherine R Tuttle; Radica Z Alicic; O Kenrik Duru; Cami R Jones; Kenn B Daratha; Susanne B Nicholas; Sterling M McPherson; Joshua J Neumiller; Douglas S Bell; Carol M Mangione; Keith C Norris Journal: JAMA Netw Open Date: 2019-12-02