Furth SL, et al. - Researchers focused on estimating time to end- renal disease (ESRD), in children with chronic kidney disease (CKD) enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. The timeline of progression was characterized by CKD staged by level of eGFR and proteinuria and could guide management strategies in children.

Methods

• Authors conducted an observational cohort study.
• They enrolled children aged 1 to 18 years in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial.
• The predictors were level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry.
• Experts estimated a composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR < 15 mL/min/1.73 m². eGFR using the CKiD-derived “bedside” equation.
• The analytical approach included was accelerated failure time models of the composite outcome using a conventional generalized gamma distribution.
• In order to amalgamate levels of similar risk, likelihood ratio statistics of nested models were used.

Results

• As per data, among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73 m², 60% were males, and 13% had UPCRs > 2.0 mg/mg at study entry.
• The risk continuum was described by 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m²) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg).
• Findings suggested that the median times to event ranged from longer than 10 years for eGFRs of 45 to 90 mL/min/1.73 m² and UPCRs < 0.5 mg/mg to 0.8 years for eGFRs of 15 to 30 mL/min/1.73 m² and UPCRs > 2 mg/mg.
• Compared to the children with nonglomerular disease, children with glomerular disease were estimated to have a 43% shorter time to event.
• Risk patterns that were consistent across the 10 subsample validation models, were demonstrated with cross-validation.