A predictive model of progression of CKD to ESRD in a predialysis pediatric interdisciplinary program.
OBJECTIVE
The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program.


METHODS
In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics.


RESULTS
The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001).


CONCLUSIONS
The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
Department of Pediatrics, Pediatric Nephrourology Unit,, †Nutrition Division, and, ‡Department of Statistics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Debora C
DC
Cerqueira
Cristina M
CM
Soares
Vanessa R
VR
Silva
Juliana O
JO
Magalhães
Isabella P
IP
Barcelos
Mariana G
MG
Duarte
Sergio V
SV
Pinheiro
Enrico A
EA
Colosimo
Ana Cristina
AC
Simões e Silva
Eduardo A
EA
Oliveira
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors
chronic kidney disease; end-stage renal disease; glomerulonephritis; pediatric nephrology