Prospective cohort analyzing risk factors for chronic kidney disease progression in children
Journal Title: Jornal de Pediatria - Year 2018, Vol 94, Issue 5
Abstract
Objective To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors. Methods This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3–4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model. Results After a median follow-up of 2.5 years (IQR=1.4–3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR=2.16, CI=1.14–4.09), nephrotic proteinuria (HR=2.89, CI=1.49–5.62), age (HR=1.10, CI=1.01–1.17), systolic blood pressure Z score (HR=1.36, CI=1.08–1.70), and anemia (HR=2.60, CI=1.41–4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR=0.25, CI=0.06–1.00) was detected. Conclusions As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied.
Authors and Affiliations
Paulo Cesar Koch-Nogueira
Keywords
Related Articles
- EP ID EP491100
- DOI 10.1016/j.jped.2017.07.015
- Views 69
- Downloads 0
Establishment of nasal breathing should be the ultimate goal to secure adequate craniofacial and airway development in children
As shown for many years and studied again by Chambi-Rocha et al.1 in this issue of the Journal, chronic mouth breathing during active craniofacial development of a child may result in anatomical changes that directly aff...
Hypothermia therapy for newborns with hypoxic ischemic encephalopathy
Objective Therapeutic hypothermia reduces cerebral injury and improves the neurological outcome secondary to hypoxic ischemic encephalopathy in newborns. It has been indicated for asphyxiated full-term or near-term newbo...
Language and reading development in the brain today: neuromarkers and the case for prediction
Objectives The goal of this article is to provide an account of language development in the brain using the new information about brain function gleaned from cognitive neuroscience. This account goes beyond describing th...
Growth in exclusively breastfed infants
Objective To address the growth of full-term children in the first 6 months of life in exclusive breastfeeding. Source of data A non-systematic review was carried out by searching the MEDLINE/PubMed, Web of Science, and...
Characterization of mortality in children with sickle cell disease diagnosed through the Newborn Screening Program
Objective To characterize the deaths of 193 children with sickle cell disease screened by a neonatal program from 1998 to 2012 and contrast the initial years with the final years. Methods Deaths were identified by activ...