CKD: novel staging system estimates time to kidney failure in children

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Takeaway

  • 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.

Study design

  • 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 2.
  • Funding: NIH (various), Boehringer Ingelheim Stiftung; European Kuratorium für Dialyse und Nierentransplantation, Baxter Extramural Grant.

Key results

  • 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 (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 2 + UPCR >2 mg/mg + glomerular disease).
  • Interval to progression 43% shorter among children with glomerular disease.

Limitations

  • Observational design; not externally validated.