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
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- EP ID EP491100
- DOI 10.1016/j.jped.2017.07.015
- Views 73
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