New staging system specific to children with CKD designed

Furth SL, et al. Am J Kidney Dis. 2017;doi:10.1053/j.ajkd.2017.12.011

Researchers have published a new staging system, reportedly the first such tool specific to children, to help doctors better predict the length of time until a child with chronic kidney disease will need to undergo a kidney transplant or receive dialysis.

“We designed a clinically useful, data-driven tool for doctors and nurses to advise parents and plan treatment, based on when a child’s kidney disease is likely to progress to the need for transplant or dialysis,” Susan L. Furth, MD, PhD, chief of nephrology at Children’s Hospital of Philadelphia and study leader, said in a press release.

The researchers drew on two, large multicenter study consortia of children with chronic kidney disease. The Chronic Kidney Disease in Children study gathered data on 891 patients from North American centers, while the Effect of Strict Blood Pressure Control and ACE Inhibition study was a European clinical trial with data from 378 pediatric patients. According to the release, the study team concluded that a combination of three factors provided the best predictors for estimating disease progression: glomerular filtration rate, proteinuria and whether the chronic kidney disease is caused by a glomerular or non-glomerular etiology.

The study team found children with glomerular disease had a faster disease progression than those with non-glomerular disease — a 43% shorter interval. Accounting for all three risk factors, the researchers divided children with CKD into six staged, color-coded groups, ranked from best to worst prognosis. Each group carries an approximate time estimate of how soon a patient will progress to the need for renal replacement therapy — either kidney transplant or dialysis.

The tool is intended to assist clinical-decision making and is not intended to influence how patients are ranked on organ donation lists.

“Follow-up studies in other patient cohorts should be done to validate this tool, but this provides a risk continuum system that we didn’t have before,” Furth said in the release.

Reference:

www.newswise.com/articles/risk-stages-defined-for-children-with-kidney-disease

Disclosure: Funding for the studies that informed this research came from the NIH (DK66143, DK66174, DK082194 and DK66116), the Boehringer Ingelheim Stiftung, the European Commission, the Kuratorium für Dialyse und Nierentransplantation, and the Baxter Extramural Grant Program.