The Association Between Kidney Disease and Mortality Among Adults With Cerebral Palsy—A Cohort Study: It Is Time to Start Talking About Kidney Health

Abstract

Objective: Recent evidence shows that adults with cerebral palsy (CP) have an increased risk for kidney disease, but nothing is known about how kidney disease integrates with their overall health. To begin understanding the importance of kidney health, the objective was to determine if kidney disease is associated with mortality among adults with CP after accounting for comorbidities common to CP and kidney disease.Methods: Data from 2016 to 2018 from adults ≥18 years with CP were used from a random 20% sample fee-for-service Medicare database. Kidney disease in 2016 was ascertained as chronic kidney disease (CKD) stages 1–4, end stage kidney disease (ESKD), nephritic and nephrotic syndrome, and renal osteodystrophy. A modified version of the Whitney Comorbidity Index (modWCI) was used, which includes 24 comorbidities relevant to CP and kidney disease. Mortality rate ratio (MRR) through the year 2018 was estimated for each kidney disease and Cox regression estimated the hazard ratio (HR) of mortality after adjusting for demographics, co-occurring neurological conditions, and the modWCI.Results: Prevalence of kidney disease was 7.3% among 16,728 adults with CP. MRR was elevated for any kidney disease (MRR = 3.14; 95%CI = 2.76–3.58) and most subtypes (MRR = 2.21–3.56; all p < 0.05). The adjusted HR of mortality remained elevated for any kidney disease (HR = 1.25; 95%CI = 1.09–1.45) and ESKD (HR = 1.38; 95%CI = 1.10–1.74).Discussion: Kidney disease, especially ESKD, is associated with mortality among adults with CP independent of comorbidities that are relevant to CP and kidney disease. Findings suggest that nephrology care should be considered as part of routine clinical care for this population.

Prevalence and incidence of chronic conditions among adults with cerebral palsy: A systematic review and meta‐analysis

“…The prevalence of CKD was 5.3% (95% CI = 3.9%-6.8%; I 2 = 98.7%, p < 0.01; n = 4025 out of 85 071; 10 studies). 29,31,32,34,38,39,44,48,49,91 The prevalence of renal disease was 0.5% to 7.1%. 28,33,45 The prevalence of renal disease among adults with intellectual disability was 0% and 6.2%.…”

Feasibility and reliability of measured glomerular filtration rate with [I125]-iothalamate among young adults with mild-to-moderate cerebral palsy

“…Emerging research highlights that chronic kidney disease is a major concern for adults with cerebral palsy (CP) ( 1 – 4 ). However, the current clinical methods, often utilizing creatinine-based estimates of glomerular filtration rate (GFR), can overestimate kidney function at the patient level leading to an underestimation of the true extent of the chronic kidney disease burden in the adult population with CP ( 1 ).…”

Preventive Care for Adults With Cerebral Palsy and Other Neurodevelopmental Disabilities: Are We Missing the Point?

“…Recent work has identified fragility fractures as a risk factor for premature cardiorespiratory morbidity and all-cause mortality for adults with CP (Etter et al, 2020 ; Whitney et al, 2020a , b ). Emerging work is documenting just how common kidney disease is and its robust association with mortality for adults with CP (Whitney et al, 2020c , d , 2021b ; Whitney and Oliverio, 2021 ). Fourth, health complications from obesity, poor bone health, and poor kidney function can be prevented, delayed, or at least better managed with early intervention strategies, but these efforts rely on sufficient detection in the clinical setting.…”