Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program

Pediatr Nephrol. 2008 Nov;23(11):2039-46. doi: 10.1007/s00467-008-0868-0. Epub 2008 Jun 17.

Abstract

The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan-Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38-145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m(2) body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m(2) per year (IQ range -24 to -5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, and miscellanea were 2.5 ml/min (IQ range -10 to +0.34), 2.2 ml/min (IQ range -5.0 to -0.52), and 0.36 ml/min (IQ range -2.5 to +2.6), respectively (P < 0.001). The results of this study support the view that children and adolescents with glomerular diseases present a faster deterioration of renal function. Therefore, patients with glomerular diseases need to be referred early to a pediatric nephrology center so that suboptimal pre-dialysis care might possibly be avoided.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Glomerulonephritis / mortality
  • Glomerulonephritis / therapy
  • Humans
  • Hypertension, Renal / mortality
  • Hypertension, Renal / therapy
  • Kaplan-Meier Estimate
  • Male
  • Patient Care Team
  • Proteinuria / mortality*
  • Proteinuria / therapy*
  • Renal Dialysis
  • Renal Insufficiency, Chronic / mortality*
  • Renal Insufficiency, Chronic / therapy*
  • Retrospective Studies
  • Treatment Outcome