TY - JOUR
T1 - Kidney Disease Progression in Children and Young Adults With Pediatric CKD
T2 - Epidemiologic Perspectives and Clinical Applications
AU - Ng, Derek K.
AU - Pierce, Christopher B.
N1 - Funding Information:
Data in this manuscript were collected by the CKiD study with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri–Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD, and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01 DK066143, U01 DK066174, U24 DK082194, U24 DK066116). The CKiD website is located at https://statepi.jhsph.edu/ckid and a list of CKiD collaborators can be found at https://statepi.jhsph.edu/ckid/site-investigators . The authors acknowledge Alvaro Muñoz for helpful comments and suggestions in the preparation of this work. The authors would like to especially thank and acknowledge the participants and their families for contributing their time, energy, and samples to help understand pediatric CKD progression, as well as the site principal investigators, coordinators, laboratory personnel, and the study monitoring board who made this study and research possible.
Funding Information:
Data in this manuscript were collected by the CKiD study with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri?Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Mu?oz, PhD, and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01 DK066143, U01 DK066174, U24 DK082194, U24 DK066116). The CKiD website is located at https://statepi.jhsph.edu/ckid and a list of CKiD collaborators can be found at https://statepi.jhsph.edu/ckid/site-investigators. The authors acknowledge Alvaro Mu?oz for helpful comments and suggestions in the preparation of this work. The authors would like to especially thank and acknowledge the participants and their families for contributing their time, energy, and samples to help understand pediatric CKD progression, as well as the site principal investigators, coordinators, laboratory personnel, and the study monitoring board who made this study and research possible. Financial disclosure and conflict of interest statements: none.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - Chronic kidney disease (CKD) progression is typically characterized as either time to a clinically meaningful event (such as dialysis or transplant), or longitudinal changes in kidney function. This review describes pediatric kidney disease progression using these two distinct frameworks by reviewing and discussing data from the Chronic Kidney Disease in Children study. We first describe new equations to estimate glomerular filtration rate (GFR) for patients younger than age 25 years, and how the average of serum creatinine-based and cystatin C–based GFR equations yield valid estimates than either alone. Next, we present a life course description of CKD onset to kidney replacement therapy, prediction models based on clinical measurements, and show the importance of diagnosis (broadly classified as nonglomerular and glomerular in origin), GFR level, and proteinuria on progression. Literature on longitudinal GFR in children and young adults are reviewed and new data are presented to characterize nonlinear changes in estimated GFR in patients younger than age 25 years. These models showed accelerated progression associated with glomerular diagnosis, lower GFR level, and higher proteinuria, which was congruent with time-to-event analyses. Descriptions of online tools for GFR estimation and risk stratification for clinical applications are presented and we offer key epidemiologic considerations for the analysis of longitudinal pediatric CKD studies.
AB - Chronic kidney disease (CKD) progression is typically characterized as either time to a clinically meaningful event (such as dialysis or transplant), or longitudinal changes in kidney function. This review describes pediatric kidney disease progression using these two distinct frameworks by reviewing and discussing data from the Chronic Kidney Disease in Children study. We first describe new equations to estimate glomerular filtration rate (GFR) for patients younger than age 25 years, and how the average of serum creatinine-based and cystatin C–based GFR equations yield valid estimates than either alone. Next, we present a life course description of CKD onset to kidney replacement therapy, prediction models based on clinical measurements, and show the importance of diagnosis (broadly classified as nonglomerular and glomerular in origin), GFR level, and proteinuria on progression. Literature on longitudinal GFR in children and young adults are reviewed and new data are presented to characterize nonlinear changes in estimated GFR in patients younger than age 25 years. These models showed accelerated progression associated with glomerular diagnosis, lower GFR level, and higher proteinuria, which was congruent with time-to-event analyses. Descriptions of online tools for GFR estimation and risk stratification for clinical applications are presented and we offer key epidemiologic considerations for the analysis of longitudinal pediatric CKD studies.
KW - Pediatric nephrology
KW - chronic kidney disease
KW - estimated glomerular filtration rate
KW - glomerular filtration rate
KW - patient-centered care
KW - pediatric kidney disease
UR - http://www.scopus.com/inward/record.url?scp=85117380967&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117380967&partnerID=8YFLogxK
U2 - 10.1016/j.semnephrol.2021.09.002
DO - 10.1016/j.semnephrol.2021.09.002
M3 - Review article
AN - SCOPUS:85117380967
VL - 41
SP - 405
EP - 415
JO - Seminars in Nephrology
JF - Seminars in Nephrology
SN - 0270-9295
IS - 5
ER -