New Staging System Estimates Time to Kidney Failure in Children

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The scheme can help inform follow-up and clinical decision-making.
The scheme can help inform follow-up and clinical decision-making.

Clinicians can use a combination of estimated glomerular filtration rate (eGFR), proteinuria, and type of chronic kidney disease to estimate how soon children will progress to end-stage renal disease (ESRD), according to new study findings published in the American Journal of Kidney Diseases.

Susan L. Furth, MD, of Children's Hospital in Philadelphia, and her colleagues examined 2 cohorts of children to determine criteria for pediatric progression to renal replacement therapy, 50% reduction in eGFR, or eGFR less than 15 mL/min/1.73 m2. The team analyzed data from 1232 children aged 1 to 18 years from the North American CKiD (Chronic Kidney Disease in Children) study and the European ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients) trial. 

Based on models, the investigators defined ESRD risk categories by eGFR stage (60–89, 45–59, 30–44, and 15–29 mL/min/1.73 m2) and urinary protein to creatinine ratio (UPCR) (less than 0.5, 0.5–2.0, and more than 2.0 mg/mg). According to the staging system, a child with eGFR of 45 to 90 mL/min/1.73 m2 and UPCR less than 0.5 mg/mg would progress to ESRD in 10 or more years. A child with an eGFR of 15 to 30 mL/min/1.73 m2 and UPCR more than 2 mg/mg would progress to ESRD in 0.8 years. Children with glomerular disease would decline almost twice as fast as those with non-glomerular disease.

The staging system is more informative than eGFR alone, the researchers said. It incorporates proteinuria rather than albuminuria because proteinuria is a more sensitive indicator of renal decline in children.

“Our goal with this analysis was to develop a clinically useful tool that would help clinicians at the bedside anticipate the timing of needed interventions, such as a pretransplantation evaluation or placement of dialysis access, and communicate these to the families of children with CKD,” Dr Furth and her colleagues stated. The next step is external validation of the system. 

Reference

Furth S, Pierce C, Hui WF, et al. Estimating time to ESRD in children With CKD. Am J K Dis. Doi:10.1053/j.ajkd.2017.12.011 

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