TY - JOUR
T1 - Urologic care and progression to end-stage kidney disease
T2 - a Chronic Kidney Disease in Children (CKiD) nested case–control study
AU - Chu, David I-Wang
AU - Abraham, A. G.
AU - Tasian, G. E.
AU - Denburg, M. R.
AU - Ross, M. E.
AU - Zderic, S. A.
AU - Furth, S. L.
N1 - Funding Information:
D.I.C. was supported by T32-DK007785-14 from the National Institutes of Health / National Institute of Diabetes and Digestive and Kidney Diseases . M.R.D. was supported by K23-DK093556 from the NIH / NIDDK . S.L.F. was supported by K24-DK078737 from the NIH / NIDDK . The NIH and NIDDK had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the official view of the NIDDK nor NIH.
Funding Information:
The Chronic Kidney Disease in Children Cohort Study (CKiD) was conducted by the CKiD Investigators and supported by the NIDDK, with additional funding from the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute ( U01-DK-66143 , U01-DK-66174 , U01DK-082194 , U01-DK-66116 ). The data and samples from the CKiD study reported here were supplied by the NIDDK Central Repositories. This manuscript does not necessarily reflect the opinions or views of the CKiD study, the NIDDK Central Repositories, or the NIDDK.
Funding Information:
D.I.C. was supported by T32-DK007785-14 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases. M.R.D. was supported by K23-DK093556 from the NIH/NIDDK. S.L.F. was supported by K24-DK078737 from the NIH/NIDDK. The NIH and NIDDK had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the official view of the NIDDK nor NIH.The Chronic Kidney Disease in Children Cohort Study (CKiD) was conducted by the CKiD Investigators and supported by the NIDDK, with additional funding from the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). The data and samples from the CKiD study reported here were supplied by the NIDDK Central Repositories. This manuscript does not necessarily reflect the opinions or views of the CKiD study, the NIDDK Central Repositories, or the NIDDK.
Publisher Copyright:
© 2019 Journal of Pediatric Urology Company
PY - 2019/5
Y1 - 2019/5
N2 - Introduction: Children with chronic kidney disease (CKD) risk progressing to end-stage kidney disease (ESKD). The majority of CKD causes in children are related to congenital anomalies of the kidney and urinary tract, which may be treated by urologic care. Objective: To examine the association of ESKD with urologic care in children with CKD. Study design: This was a nested case–control study within the Chronic Kidney Disease in Children (CKiD) prospective cohort study that included children aged 1–16 years with non-glomerular causes of CKD. The primary exposure was prior urologic referral with or without surgical intervention. Incidence density sampling matched each case of ESKD to up to three controls on duration of time from CKD onset, sex, race, age at baseline visit, and history of low birth weight. Conditional logistic regression analysis was performed to estimate rate ratios (RRs) for the incidence of ESKD. Results: Sixty-six cases of ESKD were matched to 153 controls. Median age at baseline study visit was 12 years; 67% were male, and 7% were black. Median follow-up time from CKD onset was 14.9 years. Seventy percent received urologic care, including 100% of obstructive uropathy and 96% of reflux nephropathy diagnoses. Cases had worse renal function at their baseline visit and were less likely to have received prior urologic care. After adjusting for income, education, and insurance status, urology referral with surgery was associated with 50% lower risk of ESKD (RR 0.50 [95% confidence interval [CI] 0.26–0.997), compared to no prior urologic care (Figure). After excluding obstructive uropathy and reflux nephropathy diagnoses, which were highly correlated with urologic surgery, the association was attenuated (RR 0.72, 95% CI 0.24–2.18). Discussion: In this study, urologic care was commonly but not uniformly provided to children with non-glomerular causes of CKD. Underlying specific diagnoses play an important role in both the risk of ESKD and potential benefits of urologic surgery. Conclusion: Within the CKiD cohort, children with non-glomerular causes of CKD often received urologic care. Urology referral with surgery was associated with lower risk of ESKD compared to no prior urologic care but depended on specific underlying diagnoses.[Figure
AB - Introduction: Children with chronic kidney disease (CKD) risk progressing to end-stage kidney disease (ESKD). The majority of CKD causes in children are related to congenital anomalies of the kidney and urinary tract, which may be treated by urologic care. Objective: To examine the association of ESKD with urologic care in children with CKD. Study design: This was a nested case–control study within the Chronic Kidney Disease in Children (CKiD) prospective cohort study that included children aged 1–16 years with non-glomerular causes of CKD. The primary exposure was prior urologic referral with or without surgical intervention. Incidence density sampling matched each case of ESKD to up to three controls on duration of time from CKD onset, sex, race, age at baseline visit, and history of low birth weight. Conditional logistic regression analysis was performed to estimate rate ratios (RRs) for the incidence of ESKD. Results: Sixty-six cases of ESKD were matched to 153 controls. Median age at baseline study visit was 12 years; 67% were male, and 7% were black. Median follow-up time from CKD onset was 14.9 years. Seventy percent received urologic care, including 100% of obstructive uropathy and 96% of reflux nephropathy diagnoses. Cases had worse renal function at their baseline visit and were less likely to have received prior urologic care. After adjusting for income, education, and insurance status, urology referral with surgery was associated with 50% lower risk of ESKD (RR 0.50 [95% confidence interval [CI] 0.26–0.997), compared to no prior urologic care (Figure). After excluding obstructive uropathy and reflux nephropathy diagnoses, which were highly correlated with urologic surgery, the association was attenuated (RR 0.72, 95% CI 0.24–2.18). Discussion: In this study, urologic care was commonly but not uniformly provided to children with non-glomerular causes of CKD. Underlying specific diagnoses play an important role in both the risk of ESKD and potential benefits of urologic surgery. Conclusion: Within the CKiD cohort, children with non-glomerular causes of CKD often received urologic care. Urology referral with surgery was associated with lower risk of ESKD compared to no prior urologic care but depended on specific underlying diagnoses.[Figure
KW - Chronic kidney disease
KW - End-stage kidney disease
KW - Incidence density sampling
KW - Nested case–control
KW - Urologic care
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U2 - 10.1016/j.jpurol.2019.03.008
DO - 10.1016/j.jpurol.2019.03.008
M3 - Article
C2 - 30962011
AN - SCOPUS:85063758320
SN - 1477-5131
VL - 15
SP - 266.e1-266.e7
JO - Journal of Pediatric Urology
JF - Journal of Pediatric Urology
IS - 3
ER -