Predicting Time Period To End Stage Renal Disease In Children With Kidney Disease

Highlights

• KDIGO (Kidney Disease: Improving Global Outcomes) guideline, the new staging system can help doctors predict the length of time the child has till he/ she needs to get a kidney transplant or start receiving dialysis.
• This type prognosis previously only existed for adults
• This system is data-driven and clinically useful for doctors to advise parents and plan treatment based on when a child's kidney disease is likely to progress to the need for transplant or dialysis.

The KDIGO (Kidney Disease: Improving Global Outcomes) guideline -new staging system can be used by Experts and doctors to predict the length of time the kidney disease has left for the child before he has to start dialysis or undergo a transplant surgery, finds a new study. The findings of this study are published in the American Journal of Kidney Diseases.

This type of prognosis already exists for adults. "We designed a clinically useful, data-driven tool for doctors and nurses to advise parents and plan treatment, based on when a child's kidney disease is likely to progress to the need for transplant or dialysis," said Susan L. Furth,study leader, MD, Chief of Nephrology at Children's Hospital of Philadelphia (CHOP).

Younger patients can have kidney diseases because of unknown reasons, which is almost known to affect communities in specific geographical locales. These patients have shrunken kidneys and abnormal parameters.

Currently, the doctors are supposed rely on their clinical experience to estimate when their patients' condition could progress to end-stage renal disease. "Having the proper amount of lead time is important," said Furth. She also adds that "One key factor is evaluating living donors who intend to donate one of their kidneys for transplant."

The blood work and checkups of the donor have to be current, say- the same year of the transplant, and after that one year, another full workup is necessary.

This study is based on two large multicenter study consortia of children with chronic kidney disease, and the data has been collected from 891 patients from North American centers and 378 pediatric patients from ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition) study, a European clinical trial.

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A combination of three factors had acted as the predictors for estimating the chronic kidney disease progression:

• Glomerular filtration rate (which measures how efficiently the kidney filters waste products from the blood)
• Proteinuria(the presence of protein in the urine)
• Whether the CKD is caused by a glomerular or non-glomerular etiology.

In case of glomerular kidney disease, the inflammation in glomeruli- the kidney's filtration units can impair normal function, and in non-glomerular disease, more kids are affected than adults, structural abnormalities or inherited conditions can disrupt the normal kidney function.

This research helped find out that children with the glomerular disease had faster disease progression when compared to non-glomerular disease- a significant 43 percent shorter survival interval was found in them.

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Based on the above mentioned three research factors, the scientists decided to divide the children with CKD into six staged, color-coded categories, ranked from best to worst prognosis.

Each group was carrying an approximated time estimate of how soon that particular patient will go on to progress to need a renal replacement therapy (RRT), i.e., either a kidney transplant or dialysis. In children, dialysis is considered to be a temporary solution until a transplant is arranged.

For example, a median period from baseline to renal replacement therapy can range from 10 years for the lowest-risk group to some nine and a half months for the group with the highest -risk.

The new stages are not intended to affect patients that are ranked on the kidney donation list, but instead, it is going to offer the doctors a new tool to assist them to provide families a better sense of their child's kidney disease timetable.

"Follow-up studies in other patient cohorts should be done to validate this tool, but this provides a risk continuum system that we didn't have before," added Susan L. Furth.

Reference

1. Susan L. Furth, Chris Pierce, Wun Fung Hui, Colin A. White, Craig S. Wong, Franz Schaefer, Elke Wühl, Alison G. Abraham, Bradley A. Warady. Estimating Time to ESRD in Children With CKD, American Journal of Kidney Diseases (2018).DOI: https://doi.org/10.1053/j.ajkd.2017.12.011

Source-Medindia