title: Predictors of Rapid Progression of Glomerular and Nonglomerular Kidney Disease in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort.
abstract: BACKGROUND
  Few studies have prospectively evaluated the progression of chronic kidney disease (CKD) in children and adolescents, as well as factors associated with progression.
  
  
  METHODS
  Prospective multicenter observational cohort study.
  
  
  METHODS
  496 children and adolescents with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study.
  
  
  METHODS
  Proteinuria, hypoalbuminemia, blood pressure, dyslipidemia, and anemia.
  
  
  RESULTS
  Parametric failure-time models were used to characterize adjusted associations between baseline levels and changes in predictors and time to a composite event of renal replacement therapy or 50% decline in glomerular filtration rate (GFR).
  
  
  RESULTS
  398 patients had nonglomerular disease and 98 had glomerular disease; of these, 29% and 41%, respectively, progressed to the composite event after median follow-ups of 5.2 and 3.7 years, respectively. Demographic and clinical characteristics and outcomes differed substantially according to the underlying diagnosis; hence, risk factors for progression were assessed in stratified analyses, and formal interactions by diagnosis were performed. Among patients with nonglomerular disease and after adjusting for baseline GFR, times to the composite event were significantly shorter with urinary protein-creatinine ratio > 2mg/mg, hypoalbuminemia, elevated blood pressure, dyslipidemia, male sex, and anemia, by 79%, 69%, 38%, 40%, 38%, and 45%, respectively. Among patients with glomerular disease, urinary protein-creatinine ratio >2mg/mg, hypoalbuminemia, and elevated blood pressure were associated with significantly reduced times to the composite event by 94%, 71%, and 67%, respectively. Variables expressing change in patient clinical status over the initial year of the study contributed significantly to the model, which was cross-validated internally.
  
  
  CONCLUSIONS
  Small number of events in glomerular patients and use of internal cross-validation.
  
  
  CONCLUSIONS
  Characterization and modeling of risk factors for CKD progression can be used to predict the extent to which these factors, either alone or in combination, would shorten the time to renal replacement therapy or 50% decline in GFR in children with CKD.
authors: Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO. Electronic address: bwarady@cmh.edu.
authors: Bradley A
authors: BA
authors: Warady
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Alison G
authors: AG
authors: Abraham
authors: University of Rochester, Rochester, NY.
authors: George J
authors: GJ
authors: Schwartz
authors: University of New Mexico/Children's Hospital, Albuquerque, NM.
authors: Craig S
authors: CS
authors: Wong
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Alvaro
authors: A
authors: Muñoz
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Aisha
authors: A
authors: Betoko
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Mark
authors: M
authors: Mitsnefes
authors: Children's Hospital at Montefiore, New York, NY.
authors: Frederick
authors: F
authors: Kaskel
authors: Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
authors: Larry A
authors: LA
authors: Greenbaum
authors: University of California at San Diego, La Jolla, CA.
authors: Robert H
authors: RH
authors: Mak
authors: Seattle Children's Hospital, Seattle, WA.
authors: Joseph
authors: J
authors: Flynn
authors: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors: Marva M
authors: MM
authors: Moxey-Mims
authors: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Susan
authors: S
authors: Furth
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D005921:Glomerulonephritis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D034141:Hypoalbuminemia / Q000453:epidemiology*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: Chronic Kidney Disease in Children (CKiD) Study; Pediatric; adolescents; children; chronic kidney disease (CKD); disease progression; disease trajectory; end-stage renal disease (ESRD); glomerular filtration rate (GFR); proteinuria; renal replacement therapy (RRT); risk factor; urinary protein-creatinine ratio (UPCR)