No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy report from the ItalKid Project database

Ardissino, Gianluigi; Viganò, Sara; Testa, Sara; Daccò, Valeria; Paglialonga, Fabio; Leoni, Antonio; Belingheri, Mirco; Avolio, Luigi; Ciofani, Antonio; Claris‐Appiani, Aldo; Cusi, Daniele; Edefonti, Alberto; Ammenti, Anita; Cecconi, Milva; Fede, C; Ghio, Luciana; Manna, Angela La; Maringhini, Silvio; Papalia, Teresa; Pela, Ivana; Pisanello, Lorena; Ratsch, Ilse Maria

doi:10.1093/ndt/gfm237

Cited by 60 publications

(37 citation statements)

References 19 publications

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“…In addition, use of ACE inhibitors or ARBs was associated with lower baseline urine protein excretion in children with CKD owing to glomerular, but not hypodysplasia causes in the CKiD study [44]. The lack of effect of renin-angiotensin system blockers on CKD progression in children with hypodysplasia was also seen in a case-control study by the ItalKid Project [45]. In the ESCA PE trial, intensified blood pressure control did slow disease progression in children with hypodysplasia, but the study was not designed to attribute the outcomes to ACE inhibitor use specifically [4].…”

Section: First-line Antihypertensive Medicationmentioning

confidence: 77%

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

Dionne

2015

Pediatr Nephrol

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Section: First-line Antihypertensive Medicationmentioning

confidence: 77%

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

Dionne

2015

Pediatr Nephrol

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“…Although there were no statistically significant differences in Up/c's among subjects with nonglo- merular causes of CKD whether or not ACEI/ARB medications were used, there is insufficient data to conclude that there is no benefit of using such agents among patients with nonglomerular disease. Recently, Ardissino et al reported that there was no clear evidence of ACEI efficacy on the progression of CKD in children with hypodysplastic nephropathy (30). In their cohort study comparing 41 patients on ACEI therapy and control patients who were not on ACEI therapy, both groups had stable kidney function, with the average decline of Ϫ0.31 ml/min/ 1.73m 2 /yr with ACEI therapy and Ϫ0.33 ml/min/1.73m 2 without ACEI therapy.…”

Section: Discussionmentioning

confidence: 99%

Association of Proteinuria with Race, Cause of Chronic Kidney Disease, and Glomerular Filtration Rate in the Chronic Kidney Disease in Children Study

Wong

Pierce

Cole

et al. 2009

Clinical Journal of the American Society of Nephrology

121

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Background and objectives: Proteinuria is associated with chronic kidney disease (CKD), and heavy proteinuria predicts a rapid decline in kidney function. However, the epidemiologic distribution of this important biomarker study is not well described in the pediatric CKD population.Design, setting, participants & measurements: This cross-sectional study of North American children with CKD examined the association of proteinuria among the baseline clinical variables in the cohort. Urinary protein-to-creatinine ratios (Up/c) were used to measure level of proteinuria.Results: Of the 419 subjects studied, the median GFR as measured by iohexol disappearance (iGFR) was 42 ml/min per 1.73 m 2 , median duration of CKD was six yr, and glomerular diseases accounted for 22% of the CKD diagnoses. Twenty-four percent of children had normal range (Up/c <0.2), 62% had significant, and 14% had nephrotic-range proteinuria (Up/c >2.0). A decrease in iGFR was associated with an increase in Up/c. At any level of GFR, a higher Up/c was associated with a glomerular cause of CKD and non-Caucasian race. Among subjects with a glomerular cause of CKD, Up/c was lower in subjects reporting utilization of renin-angiotensin system (RAS) antagonists (median Up/c ‫؍‬ 0.93) compared with those who did not (median Up/c ‫؍‬ 3.78).Conclusions: Proteinuria is associated with level of iGFR, cause of CKD, and race. The longitudinal study design of Chronic Kidney Disease in Children (CKiD) cohort study and the large number of subjects being studied has created an opportunity to better define the association between proteinuria and CKD progression.

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“…Children with Up/c levels Ͻ0.9 showed a slower decline of renal function and a higher rate of renal survival than those with baseline Up/c level Ͼ0.9 at 5 years (16). Furthermore, ACEi did not significantly delay the progressive decline in renal function in children with lower proteinuria compared with matched controls (17). In the ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients) trial, ACEi reduced protein excretion by approximately 50% in all forms of nephropathy within the first 6 months in children with CKD (18,19).…”

Section: Novel and Traditional Risk Factors For Gfr Decline In Childhmentioning

confidence: 95%

Insights from the Chronic Kidney Disease in Children (CKiD) Study

Copelovitch

Warady

Furth

2011

Clinical Journal of the American Society of Nephrology

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SummaryOver the last 5 years, the Chronic Kidney Disease in Children (CKiD) prospective cohort study has enrolled close to 600 children ages 1 to 16 years with mild to moderate chronic kidney disease (CKD). The main purpose of this interim report is to review the initial cross-sectional data and conclusions derived from the clinical studies conducted within CKiD in the context of findings from other pediatric CKD and end-stage renal disease (ESRD) registry and cohort studies. In particular, special emphasis was placed on studying four aspects of chronic kidney disease in children, including the identification of risk factors related to disease progression, the impact of CKD on neurocognition and quality of life (QoL), the cardiovascular morbidity associated with CKD, and identifying the causes and effects of growth failure in the context of mild to moderate kidney failure.

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No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy report from the ItalKid Project database

Abstract: We conclude that ACEi treatment does not significantly modify the naturally progressive course of hypodysplastic nephropathy in children and further studies are necessary before such treatment is routinely proposed for anti-progression purposes in children with CKD.

Cited by 60 publications

References 19 publications

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

Association of Proteinuria with Race, Cause of Chronic Kidney Disease, and Glomerular Filtration Rate in the Chronic Kidney Disease in Children Study

Insights from the Chronic Kidney Disease in Children (CKiD) Study

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