title: Progression to end-stage kidney disease in Japanese children with chronic kidney disease: results of a nationwide prospective cohort study.
abstract: BACKGROUND
  The risk of progressing to end-stage kidney disease (ESKD) and factors associated with progression in children with chronic kidney disease (CKD) are unclear, especially in Asian children.
  
  
  METHODS
  We started a nationwide, prospective cohort study of 447 Japanese children with pre-dialysis CKD in 2010, with follow-up in 2011. Progression to ESKD was analyzed by Kaplan-Meier analysis according to CKD stage. Cox regression analysis was used to identify risk factors for progression.
  
  
  RESULTS
  Data were analyzed for 429/447 children. Five patients died, of which four died before progression to ESKD. Fifty-two patients progressed to ESKD (median follow-up 1.49 years), including 9/315 patients with stage 3 CKD, 29/107 with Stage 4 CKD and 14/25 with Stage 5 CKD. One-year renal survival rates were 98.3, 80.0 and 40.9%, for Stages 3, 4 and 5 CKD, respectively. Risk factors for progression to ESKD included CKD stage [versus Stage 3; Stage 4: hazard ratio (HR) 11.12, 95% confidence interval (CI) 4.22-29.28, P < 0.001; Stage 5: HR 26.95, 95% CI 7.71-94.17, P < 0.001], heavy proteinuria (>2.0 g/g urine creatinine; HR 7.56, 95% CI 3.22-17.77, P < 0.001) and age ( < 2 years: HR 9.06; 95% CI 2.29-35.84, P = 0.002; after starting puberty: HR 4.88; 95% CI 1.85-12.85, P = 0.001).
  
  
  CONCLUSIONS
  In this cohort, 12.5% of children with pre-dialysis CKD progressed to ESKD with a median-follow-up of 1.49 years. Children with advanced (Stage 4/5) CKD were particularly likely to progress. To our knowledge, this is the first, nationwide, prospective cohort study of children with pre-dialysis CKD in Asia.
authors: Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors: Kenji
authors: K
authors: Ishikura
authors: Osamu
authors: O
authors: Uemura
authors: Yuko
authors: Y
authors: Hamasaki
authors: Shuichi
authors: S
authors: Ito
authors: Naohiro
authors: N
authors: Wada
authors: Motoshi
authors: M
authors: Hattori
authors: Yasuo
authors: Y
authors: Ohashi
authors: Ryojiro
authors: R
authors: Tanaka
authors: Koichi
authors: K
authors: Nakanishi
authors: Tetsuji
authors: T
authors: Kaneko
authors: Masataka
authors: M
authors: Honda
mesh_terms: D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Asia; child; chronic kidney disease; end-stage kidney disease; prognosis