Determinants of eGFR at start of renal replacement therapy in paediatric patients

Stralen, Karlijn J. van; Tizard, E. Jane; Jager, Kitty J.; Schaefer, Franz; Vondrák, Karel; Groothoff, Jaap W.; Podracká, Ľudmila; Holmberg, Christer; Jankauskienė, Augustina; Lewis, Malcolm; Damme‐Lombaerts, Rita Van; Mota, Conceição; Niaudet, Patrick; Novljan, Gregor; Peco-Antić, Amira; Sahpazova, Emilija; Toots, Ülle; Verrina, Enrico

doi:10.1093/ndt/gfq215

Cited by 41 publications

(32 citation statements)

References 23 publications

(26 reference statements)

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“…Our study findings are comparable to other pediatric reports at 21%-35% (19,25), although these studies have defined LR using a shorter time interval at #1 month between initial presentation and commencement of RRT. It is somewhat disappointing to note that rates of LR in the United Kingdom have not changed significantly over the last two decades, despite significant investment in health care during this time and increasing evidence supporting ER of children with CKD to pediatric nephrology centers.…”

Section: Discussionsupporting

confidence: 89%

“…As expected, our study findings were similar, with 57.6% of patients with eGFR,20 ml/min per 1.73 m 2 at first review. These data do not represent the eGFR at presentation in all children presenting with CKD to a nephrologist, but only those who commenced RRT during the study period; this is likely the explanation for the considerably lower eGFR overall at first nephrology review in this and other similar cohorts (25).…”

Section: Discussionmentioning

confidence: 82%

“…A recent Europe-wide renal registry study (25), which includes some data from the United Kingdom, reported LR using eGFR at presentation based definitions and observed that 60% of patients had an eGFR,20 ml/min per 1.73 m 2 when first seen by nephrologist. As expected, our study findings were similar, with 57.6% of patients with eGFR,20 ml/min per 1.73 m 2 at first review.…”

Section: Discussionmentioning

confidence: 99%

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Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Pruthi

Casula

Inward

et al. 2016

CJASN

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Background and objectives We evaluated rates and factors associating with late referral (LR) and describe association of LR with access to renal transplantation and patient survival in children in the United Kingdom. Early requirement of RRT within 90 days of presentation to a pediatric nephrologist was classed as a LR, and those .90 days as an early referral (ER).Design, setting, participants, & measurements We included patients who commenced RRT, aged $3 months and ,16 years, from 1996 to 2012.Results Of 1603 patients, 25.5% (n=408) were LR, of which 75% commenced RRT in ,30 days following presentation. Those with LR were more likely to be older at presentation, female, and black. The primary renal disease in LR was more likely to be glomerular disease (odds ratio [OR], 1.6; 95% confidence interval [95% CI], 1.12 to 2.29), renal malignancy and associated diseases (OR, 4.11; 95% CI, 1.57 to 10.72), tubulo-interstitial diseases (OR, 2.37; 95% CI, 1.49 to 3.78), or an uncertain renal etiology (OR, 5.75; 95% CI, 3.1 to 10.65). Significant differences in rates of transplantation between LR and ER remained up to 1-year following commencement of dialysis (21% versus 61%, P,0.001) but with no differences for donor source (33.3% and 35.3% living donor in LR and ER respectively, P=0.55). The median (interquartile range) follow-up time was 4.8 years (2.9-7.6). There were 55 deaths with no statistically significant difference in survival in the LR group compared with the ER group (hazard ratio, 1.30; 95% CI, 0.7 to 2.3; P=0.40).Conclusions We found that 25% of children starting RRT in the United Kingdom receive a LR to pediatric renal services, with little change observed over the past two decades. Those with LR are unable to benefit from preemptive transplantation and require longer periods of dialysis before transplantation. There is an urgent need to understand causes of avoidable LR and develop strategies to improve kidney awareness more widely among health care professionals looking after children.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Pruthi

Casula

Inward

et al. 2016

CJASN

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“…Within the registry, clinical data are collected annually as reported elsewhere (16,17). Data obtained for the purpose of this study included date of birth, sex, primary renal disease, date of start of RRT, treatment modality (hemodialysis [HD], peritoneal dialysis [PD], or transplantation) and dates of change in treatment modality, donor source, height at start of RRT and at last followup.…”

Section: Data Collectionmentioning

confidence: 99%

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Harambat¹,

Bonthuis²,

Stralen

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Growth and final height are of major concern in children with ESRD. This study sought to describe the distribution of adult height of patients who started renal replacement therapy (RRT) during childhood and to identify determinants of final height in a large cohort of RRT children.Design, setting, participants, & measurements A total of 1612 patients from 20 European countries who started RRT before 19 years of age and reached final height between 1990 and 2011 were included. Linear regression analyses were performed to calculate adjusted mean final height SD score (SDS) and to investigate its potential determinants.Results The median final height SDS was 21.65 (median of 168 cm in boys and 155 cm in girls). Fifty-five percent of patients attained an adult height within the normal range. Adjusted for age at start of RRT and primary renal diseases, final height increased significantly over time from 22.06 SDS in children who reached adulthood in 1990-1995 to 21.33 SDS among those reaching adulthood in 2006-2011. Older age at start of RRT, more recent period of start of RRT, cumulative percentage time on a functioning graft, and greater height SDS at initiation of RRT were independently associated with a higher final height SDS. Patients with congenital anomalies of the kidney and urinary tract and metabolic disorders had a lower final height than those with other primary renal diseases.Conclusions Although final height remains suboptimal in children with ESRD, it has consistently improved over time.

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“…It was also assayed for the presence of biologically active SOCS3, SOCS5, IL-6 and IL-20 using the ELISA technique. Glomerular filtration rate was calculated using the Schwartz formula [18].…”

Section: Controlsmentioning

confidence: 99%

SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

Ostalska‐Nowicka

Śmiech²,

Jaroniec³

et al. 2012

Folia Histochem Cytobiol.

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Suppressors of Cytokine Signaling (SOCS) inhibit Signal Transducers and Activators of Transcription (STATs) phosphorylation by binding and inhibiting Janus Kinases (JaKs). The aim of the present study was to evaluate the influence of glucocorticosteroids on the JaK/STAT signaling pathway in the leukocytes of nephrotic syndrome (NS) patients. The study group was composed of 34 steroid sensitive NS (SSNS) children and 20 steroid resistant NS (SRNS) subjects. Gene expression was assessed by real-time PCR using pre-designed human JaK/STAT PCR array. Protein expression was evaluated using ELISA assay (plasma concentration) and immunofluorescence (in situ protein expression). In SSNS children, the initial increased expression of JaK1, JaK2, JaK3, STAT1, STAT2, STAT6, TYK2, SOCS1, SOCS2, SOCS3, SOCS4 and SOCS5 was reduced back to the control limits. Similarly, in SRNS patients the increased levels of almost all mRNA expressions for the abovementioned genes were decreased, with the exceptions of SOCS3 and SOCS5 expressions. These mRNA expressions were still significantly increased and correlated with early unfavorable course of nephrotic syndrome in children. Plasma levels of SOCS3, SOCS5, IL-6 and IL-20 were significantly increased in SRNS subjects after six weeks of steroids medication compared to SSNS and control participants. We conclude that SOCS3 and SOCS5 increased mRNA expressions might predict initial resistance

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Determinants of eGFR at start of renal replacement therapy in paediatric patients

Cited by 41 publications

References 23 publications

Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

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