Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program.
The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan-Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38-145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m(2) body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m(2) per year (IQ range -24 to -5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, and miscellanea were 2.5 ml/min (IQ range -10 to +0.34), 2.2 ml/min (IQ range -5.0 to -0.52), and 0.36 ml/min (IQ range -2.5 to +2.6), respectively (P < 0.001). The results of this study support the view that children and adolescents with glomerular diseases present a faster deterioration of renal function. Therefore, patients with glomerular diseases need to be referred early to a pediatric nephrology center so that suboptimal pre-dialysis care might possibly be avoided.
Pediatric Nephrourology Unit, Federal University of Minas Gerais (UFMG), MG, Brazil.
Cristina M Bouissou
CM
Soares
José Silvério S
JS
Diniz
Eleonora M
EM
Lima
Jose M Penido
JM
Silva
Gilce R
GR
Oliveira
Monica R
MR
Canhestro
Enrico A
EA
Colosimo
Ana Cristina
AC
Simoes e Silva
Eduardo A
EA
Oliveira
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000401:mortality / Q000628:therapy; D006801:Humans; D006977:Hypertension, Renal / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D010348:Patient Care Team; D011507:Proteinuria / Q000401:mortality* / Q000628:therapy*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome