title: Association between clinical risk factors and progression of chronic kidney disease in children.
abstract: OBJECTIVE
  Children with chronic kidney disease (CKD) have an increased risk of progression to ESRD. There is a need to identify treatments to slow the progression of CKD, yet there are limited data regarding clinical risk factors that may be suitable targets to slow progression.
  
  
  METHODS
  We performed a retrospective cohort study using the North American Pediatric Renal Trials and Cooperative Studies CKD database. There were 4166 pediatric subjects with CKD stages II to IV. Disease progression was defined as a GFR on follow-up of <15 ml/min per 1.73 m(2) or termination in the registry because of dialysis or transplantation. We used Kaplan-Meier and Cox proportional hazards methods to describe progression rates and determine factors associated with CKD progression.
  
  
  RESULTS
  In the univariate analysis, CKD progression was associated with age, gender, race, primary disease, CKD stage, registration year, hematocrit, albumin, corrected calcium, corrected phosphorus, and use of certain medications. Factors that remained significant in the multivariate analysis were age, primary disease, CKD stage, registration year, hypertension, corrected phosphorus, corrected calcium, albumin, hematocrit, and medication proxies for anemia and short stature.
  
  
  CONCLUSIONS
  There are multiple risk factors associated with disease progression in the pediatric CKD population. Factors that may be amenable to intervention include anemia, hypoalbuminemia, hyperphosphatemia, hypocalcemia, hypertension, and short stature. Because of the retrospective nature of our study, confirmation of our results from ongoing prospective studies is warranted before recommending prospective interventional trials.
authors.affiliation: Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA. astaples@salud.unm.edu
authors.forename: Amy O
authors.initials: AO
authors.lastname: Staples
authors.forename: Larry A
authors.initials: LA
authors.lastname: Greenbaum
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Smith
authors.forename: Debbie S
authors.initials: DS
authors.lastname: Gipson
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Karen
authors.initials: K
authors.lastname: Martz
authors.forename: Craig S
authors.initials: CS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors
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