Predictors and consequences of higher estimated glomerular filtration rate at dialysis initiation

Meredith A. Atkinson, Pooja C. Oberai, Alicia M. Neu, Barbara A. Fivush, Rulan S. Parekh

Research output: Contribution to journalArticle

Abstract

There have been no studies in pediatric dialysis patients to evaluate the impact of higher estimated glomerular filtration rate (eGFR) at dialysis initiation on clinical outcomes. Baseline clinical and demographic information was collected for children aged 1-18 years undergoing incident dialysis from 1995-2002 within the United States Renal Data System. Baseline eGFRs calculated by the Schwartz formula were categorized as high (>15 ml/min/1.73 m 2) or low (≤15 ml/min/1.73 m2). We determined predictors of eGFR at baseline, and associations between baseline eGFR and subsequent hospitalization for hypertension (HTN) or pulmonary edema (PE) in a longitudinal nonconcurrent pediatric end-stage renal disease (ESRD) cohort. Twenty percent of children had a high eGFR at initiation. Black children were less likely to initiate dialysis with a high eGFR [adjusted odds ratio (adjOR) 0.71, p<0.001]. Girls were less likely to have a high eGFR at baseline (adjOR 0.71, p<0.001). Children who received predialysis erythropoietin therapy were more likely to start dialysis with a high eGFR (adjOR 6.67, p<0.001). Children with higher baseline eGFR were found to have a 21% decreased risk of hospitalization [adjusted hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96, p=0.02]. It is not known whether this clinical benefit will result in decreased mortality and complication rates from cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)1153-1161
Number of pages9
JournalPediatric Nephrology
Volume25
Issue number6
DOIs
StatePublished - Jun 1 2010

Keywords

  • End-stage renal disease
  • Hospitalization
  • Morbidity
  • Pediatric
  • Residual kidney function

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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