Abstract
Background: Clinical care decisions to treat chronic kidney disease (CKD) in a growing child must often be made without the benefit of evidence from clinical trials. We used observational data from the Chronic Kidney Disease in Children cohort to estimate the effectiveness of renin–angiotensin II–aldosterone system blockade (RAAS) to delay renal replacement therapy (RRT) in children with CKD. Methods: A total of 851 participants (median age: 11 years, median glomerular filtration rate [GFR]: 52 ml/min/1.73 m2, median urine protein to creatinine ratio: 0.35 mg/mg) were included. RAAS use was reported at annual study visits. Both Cox proportional hazards models with time-varying RAAS exposure and Cox marginal structural models (MSM) were used to evaluate the effect of RAAS use on time to RRT. Analyses were adjusted or weighted to control for age, male sex, glomerular diagnosis, GFR, nephrotic range proteinuria, anemia, elevated blood pressure, acidosis, elevated phosphate and elevated potassium. Results: There were 217 RRT events over a 4.1-year median follow-up. At baseline, 472 children (55 %) were prevalent RAAS users, who were more likely to be older, have a glomerular etiology, have higher urine protein, be anemic, have elevated serum phosphate and potassium, take more medications, but less likely to have elevated blood pressure, compared with non-users. RAAS use was found to reduce the risk of RRT by 21 % (hazard ratio: 0.79) to 37 % (hazard ratio: 0.63) from standard regression adjustment and MSM models, respectively. Conclusions: These results support inferences from adult studies of a substantial benefit of RAAS use in pediatric CKD patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-7 |
| Number of pages | 7 |
| Journal | Pediatric Nephrology |
| DOIs | |
| State | Accepted/In press - Nov 8 2016 |
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Keywords
- ACE inhibitor
- Chronic kidney disease
- End-stage renal disease
- Marginal structural model
- Renal replacement therapy
- Renin–angiotensin system
- Time-varying covariates
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Nephrology
Cite this
Renin–angiotensin II–aldosterone system blockers and time to renal replacement therapy in children with CKD. / Abraham, Alison Gump; Betoko, Aisha; Fadrowski, Jeffrey J.; Pierce, Christopher; Furth, Susan L.; Warady, Bradley A.; Munoz, Alvaro.
In: Pediatric Nephrology, 08.11.2016, p. 1-7.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Renin–angiotensin II–aldosterone system blockers and time to renal replacement therapy in children with CKD
AU - Abraham, Alison Gump
AU - Betoko, Aisha
AU - Fadrowski, Jeffrey J.
AU - Pierce, Christopher
AU - Furth, Susan L.
AU - Warady, Bradley A.
AU - Munoz, Alvaro
PY - 2016/11/8
Y1 - 2016/11/8
N2 - Background: Clinical care decisions to treat chronic kidney disease (CKD) in a growing child must often be made without the benefit of evidence from clinical trials. We used observational data from the Chronic Kidney Disease in Children cohort to estimate the effectiveness of renin–angiotensin II–aldosterone system blockade (RAAS) to delay renal replacement therapy (RRT) in children with CKD. Methods: A total of 851 participants (median age: 11 years, median glomerular filtration rate [GFR]: 52 ml/min/1.73 m2, median urine protein to creatinine ratio: 0.35 mg/mg) were included. RAAS use was reported at annual study visits. Both Cox proportional hazards models with time-varying RAAS exposure and Cox marginal structural models (MSM) were used to evaluate the effect of RAAS use on time to RRT. Analyses were adjusted or weighted to control for age, male sex, glomerular diagnosis, GFR, nephrotic range proteinuria, anemia, elevated blood pressure, acidosis, elevated phosphate and elevated potassium. Results: There were 217 RRT events over a 4.1-year median follow-up. At baseline, 472 children (55 %) were prevalent RAAS users, who were more likely to be older, have a glomerular etiology, have higher urine protein, be anemic, have elevated serum phosphate and potassium, take more medications, but less likely to have elevated blood pressure, compared with non-users. RAAS use was found to reduce the risk of RRT by 21 % (hazard ratio: 0.79) to 37 % (hazard ratio: 0.63) from standard regression adjustment and MSM models, respectively. Conclusions: These results support inferences from adult studies of a substantial benefit of RAAS use in pediatric CKD patients.
AB - Background: Clinical care decisions to treat chronic kidney disease (CKD) in a growing child must often be made without the benefit of evidence from clinical trials. We used observational data from the Chronic Kidney Disease in Children cohort to estimate the effectiveness of renin–angiotensin II–aldosterone system blockade (RAAS) to delay renal replacement therapy (RRT) in children with CKD. Methods: A total of 851 participants (median age: 11 years, median glomerular filtration rate [GFR]: 52 ml/min/1.73 m2, median urine protein to creatinine ratio: 0.35 mg/mg) were included. RAAS use was reported at annual study visits. Both Cox proportional hazards models with time-varying RAAS exposure and Cox marginal structural models (MSM) were used to evaluate the effect of RAAS use on time to RRT. Analyses were adjusted or weighted to control for age, male sex, glomerular diagnosis, GFR, nephrotic range proteinuria, anemia, elevated blood pressure, acidosis, elevated phosphate and elevated potassium. Results: There were 217 RRT events over a 4.1-year median follow-up. At baseline, 472 children (55 %) were prevalent RAAS users, who were more likely to be older, have a glomerular etiology, have higher urine protein, be anemic, have elevated serum phosphate and potassium, take more medications, but less likely to have elevated blood pressure, compared with non-users. RAAS use was found to reduce the risk of RRT by 21 % (hazard ratio: 0.79) to 37 % (hazard ratio: 0.63) from standard regression adjustment and MSM models, respectively. Conclusions: These results support inferences from adult studies of a substantial benefit of RAAS use in pediatric CKD patients.
KW - ACE inhibitor
KW - Chronic kidney disease
KW - End-stage renal disease
KW - Marginal structural model
KW - Renal replacement therapy
KW - Renin–angiotensin system
KW - Time-varying covariates
UR - http://www.scopus.com/inward/record.url?scp=84994417774&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994417774&partnerID=8YFLogxK
U2 - 10.1007/s00467-016-3512-4
DO - 10.1007/s00467-016-3512-4
M3 - Article
C2 - 27826732
AN - SCOPUS:84994417774
SP - 1
EP - 7
JO - Pediatric Nephrology
JF - Pediatric Nephrology
SN - 0931-041X
ER -