- Time to progression from chronic kidney disease (CKD) to end-stage renal disease can be estimated in children using a combination of estimated glomerular filtration rate (eGFR), proteinuria, and presence/absence of glomerular disease.
Why this matters
- This is the first staging tool designed specifically for children.
- Data from 2 large multicenter studies of 1169 children (median age, 12 years); CKiD (North American, 73%), and ESCAPE (European, 27%).
- Composite endpoint for CKD progression: renal replacement therapy, 50% decrease in eGFR, or eGFR <15 mL/minutes/1.73 m2.
- Funding: NIH (various), Boehringer Ingelheim Stiftung; European Kuratorium für Dialyse und Nierentransplantation, Baxter Extramural Grant.
- Median baseline eGFR was 47 mL/minutes/1.73 m2; 13% had urine protein-creatinine ratio (UPCR) >2.0 mg/mg; 75% had nonglomerular diagnoses; 35% progressed during median 3.8 years.
- 6 color-coded risk stages (A-F) were established using combinations of eGFR (60-89, 45-59, 30-44, and 15-29 mL/minutes/1.73 m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0 mg/mg), stratified by presence/absence of glomerular disease.
- Time to progression ranged from 10+ years (eGFR, 45-90 mL/minutes/1.73 m2 + UPCR <0.5 mg/mg) to 0.8 years (eGFR, 15-30 mL/minutes/1.73 m2 + UPCR >2 mg/mg + glomerular disease).
- Interval to progression 43% shorter among children with glomerular disease.
- Observational design; not externally validated.