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Evaluation of the Factors Affecting Disease Progression in Children with Predialysis Chronic Kidney Disease

Year 2024, Volume: 46 Issue: 3, 351 - 358, 27.05.2024
https://doi.org/10.20515/otd.1416345

Abstract

Chronic kidney disease (CKD) is an important health problem that can progress to end-stage renal disease (ESRD). In our study, it was aimed to evaluate the factors affecting disease progression in children with the diagnosis of predialysis CKD. In our study, the data from 25 patients with predialysis CKD were retrospectively reviewed. The laboratory findings were evaluated at the time of admission, at the second and fourth years. The mean follow-up period of the patients was 6.6 ± 2.27 years. Thirteen patients showed progression in the CKD stage. There was a statistically significant difference between the GFR at admission and the GFR at the fourth year follow-up (p=0.043). In patients with a significant decrease in GFR, serum uric acid levels at admission was statistically significantly higher than in patients without a decrease in GFR (p=0.015). Serum uric acid levels had predictive value for the decrease in GFR (area under curve: 0.82, cut-off value:6.1±0.89 mg/dL, sensitivity:83.1%, specificity:67.4%, p=0.028). The frequency of hypertension was higher in patients with a decrease in GFR compared to patients without a decrease in GFR (p=0.001). In Cox regression analysis, significant correlations were found between the serum uric acid levels and the presence of hypertension at admission and a decrease in GFR (hazard ratio:1.536, 95%confidence interval:1.214-1.903, p=0.032, Hazard ratio:1.873, 95%confidence interval:1.164-2.287, p=0.041, respectively).Identification of the factors that cause the progression of chronic kidney disease and treatments to prevent these factors may slow the progression to ESRD in children.

References

  • 1. Kidney D. Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Supp 2012;2(1):1-138.
  • 2. Furth SL, Cole SR, Fadrowski JJ, Gerson A, Pierce CB, Chandra M, et al. The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease. Pediatr Nephrol 2007;22(2):265-71.
  • 3. Şirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 1995;9(5):549-52.1-3
  • 4. National KF. III. Clinical practice recommendations for anemia in chronic kidney disease in children. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2006;47(5 Suppl 3):S86.
  • 5. Levey AS, Coresh J, Bolton K, Culleton B, Harvey KS, Ikizler TA, et al. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Diseases. 2002;39(2 SUPPL. 1).
  • 6. Nephrology P. Ellis D. Avner, William E. Harmon, Patrick Niaudet, Norishige Yo-shikawa, еds. 6 еd. Springer-Verlag Berlin Heidelberg; 2009.
  • 7. Waterlow J. Classification and definition of protein-calorie malnutrition. British medical journal. 1972;3(5826):566.
  • 8. Pediatrics AAO. National high blood pressure education program working group on high blood pressure in children and adolescents. Pediatrics. 2004;114(Supplement 2):iv-iv
  • 9. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2001;37(1):S66-S70.
  • 10. Yosypiv IV. Congenital anomalies of the kidney and urinary tract: a genetic disorder? International journal of nephrology. 2012;2012:909083.
  • 11. Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003;111(4):e382-e7.
  • 12. Staples AO, Greenbaum LA, Smith JM, Gipson DS, Filler G, Warady BA, et al. Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol 2010;5(12):2172-9.
  • 13. Wühl E, van Stralen KJ, Verrina E, Bjerre A, Wanner C, Heaf JG, et al. Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract. Clin J Am Soc Nephrol 2013;8(1):67-74.
  • 14. Komers R, Oyama TT, Beard DR, Tikellis C, Xu B, Lotspeich DF, et al. Rho kinase inhibition protects kidneys from diabetic nephropathy without reducing blood pressure. Kidney Int 2011;79(4):432-42.
  • 15. Taal MW, Brenner BM. Renoprotective benefits of RAS inhibition: from ACEI to angiotensin II antagonists. Kidney Int 2000;57(5):1803-17.
  • 16. Yamout H, Lazich I, Bakris GL. Blood pressure, hypertension, RAAS blockade, and drug therapy in diabetic kidney disease. Adv Chronic Kidney Dis 2014;21(3):281-6.
  • 17. Derneği TK. Türk kardiyoloji derneği ulusal hipertansiyon tedavi ve takip kılavuzu. Erişim tarihi. 2017;10.
  • 18. Group ET. Strict blood-pressure control and progression of renal failure in children. N Engl J Med 2009;361(17):1639-50.
  • 19. 19.Wingen A-M, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. Lancet 1997;349(9059):1117-23.
  • 20. Haig A. Uric acid as a factor in the causation of disease: Churchill; 1908.
  • 21. Masugi F, Ogihara T, Hashizume K, Hasegawa T, Sakaguchi K, Kumahara Y. Changes in plasma lipids and uric acid with sodium loading and sodium depletion in patients with essential hypertension. J Hum Hypertens 1988;1(4):293-8.
  • 22. Mazzali M, Hughes J, Kim Y-G, Jefferson JA, Kang D-H, Gordon KL, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001;38(5):1101-6.
  • 23. Sharbaf FG, Assadi F. Effect of allopurinol on the glomerular filtration rate of children with chronic kidney disease. Pediatr Nephrol 2018 Aug;33(8):1405-9.
  • 24. Miao Y, Ottenbros SA, Laverman GD, Brenner BM, Cooper ME, Parving H-H, et al. Effect of a reduction in uric acid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of endpoints in non-insulin-dependent diabetes mellitus with the Angiotensin II Antagonist Losartan Trial. Hypertension 2011;58(1):2-7.
  • 25. Young EW, Akiba T, Albert JM, McCarthy JT, Kerr PG, Mendelssohn DC, et al. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:34-8.

Prediyaliz kronik böbrek hastalığı olan çocuklarda hastalık ilerlemesini etkileyen faktörlerin değerlendirilmesi

Year 2024, Volume: 46 Issue: 3, 351 - 358, 27.05.2024
https://doi.org/10.20515/otd.1416345

Abstract

Kronik böbrek hastalığı (KBH), son dönem böbrek hastalığına (SDBH) ilerleyebilen önemli bir sağlık sorunudur. Çalışmamızda prediyaliz KBH tanısı alan çocuklarda hastalığın seyrini etkileyen faktörlerin değerlendirilmesi amaçlandı. Çalışmamızda prediyaliz KBH olan 25 hastanın verileri retrospektif olarak incelendi. Başvuru anında, ikinci ve dördüncü yıldaki laboratuvar bulguları değerlendirildi. Hastaların ortalama takip süresi 6,6 ± 2,27 yıldı. On üç hastada KBH evresinde ilerleme görüldü. Başvuru anındaki glomerul filtrasyon hızı (GFH) ile dördüncü yıl takipteki GFH arasında istatistiksel olarak anlamlı fark vardı (p= 0,043). GFH'de anlamlı azalma olan hastaların başvuru anındaki serum ürik asit düzeyleri, GFH'de azalma olmayan hastalara göre istatistiksel olarak anlamlı derecede yüksekti (p= 0,015). Serum ürik asit düzeyleri GFH'deki düşüş için öngörücü değere sahipti (eğri altındaki alan: 0,82, eşik değer: 6,1 ± 0,89 mg/dL, duyarlılık: %83,1, özgüllük: %67,4, p= 0,028). GFH'si azalan hastalarda, GFH'si düşmeyen hastalara göre hipertansiyon görülme sıklığı daha yüksekti (p= 0,001). Cox regresyon analizinde serum ürik asit düzeyi ile başvuru sırasında hipertansiyon varlığı ve GFH'de azalma arasında anlamlı korelasyonlar bulundu (sırası ile hazard oranı: 1,536, %95 güven aralığı: 1,214-1,903, p= 0,032, hazard oranı: 1,873). , %95 güven aralığı: 1,164-2,287, p= 0,041). Kronik böbrek hastalığının ilerlemesine neden olan faktörlerin belirlenmesi ve bu faktörlerin önlenmesine yönelik tedaviler çocuklarda SDBH'nin ilerlemesini yavaşlatabilir.

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University X (Date: 03.23.2018/No: 25403353 - 050.99 - E.30894).

Supporting Institution

Nil

Thanks

Nil

References

  • 1. Kidney D. Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Supp 2012;2(1):1-138.
  • 2. Furth SL, Cole SR, Fadrowski JJ, Gerson A, Pierce CB, Chandra M, et al. The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease. Pediatr Nephrol 2007;22(2):265-71.
  • 3. Şirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 1995;9(5):549-52.1-3
  • 4. National KF. III. Clinical practice recommendations for anemia in chronic kidney disease in children. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2006;47(5 Suppl 3):S86.
  • 5. Levey AS, Coresh J, Bolton K, Culleton B, Harvey KS, Ikizler TA, et al. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Diseases. 2002;39(2 SUPPL. 1).
  • 6. Nephrology P. Ellis D. Avner, William E. Harmon, Patrick Niaudet, Norishige Yo-shikawa, еds. 6 еd. Springer-Verlag Berlin Heidelberg; 2009.
  • 7. Waterlow J. Classification and definition of protein-calorie malnutrition. British medical journal. 1972;3(5826):566.
  • 8. Pediatrics AAO. National high blood pressure education program working group on high blood pressure in children and adolescents. Pediatrics. 2004;114(Supplement 2):iv-iv
  • 9. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2001;37(1):S66-S70.
  • 10. Yosypiv IV. Congenital anomalies of the kidney and urinary tract: a genetic disorder? International journal of nephrology. 2012;2012:909083.
  • 11. Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003;111(4):e382-e7.
  • 12. Staples AO, Greenbaum LA, Smith JM, Gipson DS, Filler G, Warady BA, et al. Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol 2010;5(12):2172-9.
  • 13. Wühl E, van Stralen KJ, Verrina E, Bjerre A, Wanner C, Heaf JG, et al. Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract. Clin J Am Soc Nephrol 2013;8(1):67-74.
  • 14. Komers R, Oyama TT, Beard DR, Tikellis C, Xu B, Lotspeich DF, et al. Rho kinase inhibition protects kidneys from diabetic nephropathy without reducing blood pressure. Kidney Int 2011;79(4):432-42.
  • 15. Taal MW, Brenner BM. Renoprotective benefits of RAS inhibition: from ACEI to angiotensin II antagonists. Kidney Int 2000;57(5):1803-17.
  • 16. Yamout H, Lazich I, Bakris GL. Blood pressure, hypertension, RAAS blockade, and drug therapy in diabetic kidney disease. Adv Chronic Kidney Dis 2014;21(3):281-6.
  • 17. Derneği TK. Türk kardiyoloji derneği ulusal hipertansiyon tedavi ve takip kılavuzu. Erişim tarihi. 2017;10.
  • 18. Group ET. Strict blood-pressure control and progression of renal failure in children. N Engl J Med 2009;361(17):1639-50.
  • 19. 19.Wingen A-M, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. Lancet 1997;349(9059):1117-23.
  • 20. Haig A. Uric acid as a factor in the causation of disease: Churchill; 1908.
  • 21. Masugi F, Ogihara T, Hashizume K, Hasegawa T, Sakaguchi K, Kumahara Y. Changes in plasma lipids and uric acid with sodium loading and sodium depletion in patients with essential hypertension. J Hum Hypertens 1988;1(4):293-8.
  • 22. Mazzali M, Hughes J, Kim Y-G, Jefferson JA, Kang D-H, Gordon KL, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001;38(5):1101-6.
  • 23. Sharbaf FG, Assadi F. Effect of allopurinol on the glomerular filtration rate of children with chronic kidney disease. Pediatr Nephrol 2018 Aug;33(8):1405-9.
  • 24. Miao Y, Ottenbros SA, Laverman GD, Brenner BM, Cooper ME, Parving H-H, et al. Effect of a reduction in uric acid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of endpoints in non-insulin-dependent diabetes mellitus with the Angiotensin II Antagonist Losartan Trial. Hypertension 2011;58(1):2-7.
  • 25. Young EW, Akiba T, Albert JM, McCarthy JT, Kerr PG, Mendelssohn DC, et al. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:34-8.
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Pediatric Nephrology
Journal Section ORİJİNAL MAKALE
Authors

Havva İpek Demir 0000-0002-7717-3319

Nuran Cetın 0000-0001-5763-9815

Aslı Kavaz Tufan 0000-0003-1311-9468

Publication Date May 27, 2024
Submission Date January 9, 2024
Acceptance Date March 11, 2024
Published in Issue Year 2024 Volume: 46 Issue: 3

Cite

Vancouver Demir Hİ, Cetın N, Kavaz Tufan A. Prediyaliz kronik böbrek hastalığı olan çocuklarda hastalık ilerlemesini etkileyen faktörlerin değerlendirilmesi. Osmangazi Tıp Dergisi. 2024;46(3):351-8.


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