EHRs can be used to study large cohorts of children with CKD
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Researchers successfully used electronic health record data to measure and identify risk factors of chronic kidney disease progression in a large cohort of pediatric patients, according to a speaker at ASN Kidney Week.
“While landmark prospective cohort studies by Chronic Kidney Disease in Children (CKiD) have been instrumental in forming the foundation of knowledge of CKD in children, there remain significant gaps in our knowledge in large part due to its rarity,” Caroline A. Gluck, MD, MTR, from Nemours Alfred I. duPont Hospital for Children, said. “The goals of this study were to use real work electronic health record data to study kidney function decline in a large cohort of children and model CKD progression.”
In a retrospective cohort study, researchers identified 7,395 children (median age, 14.1 years; 36% female; 23% were Black) with CKD and aged 1 year to 18 years between 2009 and 2020 using EHR data from PEDSnet.
“We used a composite outcome for CKD progression: having eGFR less than 15 [mL/min/1.73 m2] or requiring chronic dialysis or kidney transplant,” Gluck said.
Patients were categorized into glomerular, non-glomerular and malignancy sub-cohorts and were evaluated on the impact of hypertension (at least two visits with hypertension code) and proteinuria (at least one lab value of 1+) within 2 years of cohort entrance on progression.
Among the patients, 36% had proteinuria, 46% had hypertension and the median initial eGFR was 75.5 mL/min/1.73 m2. Analyses revealed children with glomerular CKD (n=5,739) were more likely to reach outcomes than those with malignancies (n=565) or without glomerular CKD (n=1,091). Similarly, children with hypertension, proteinuria or both were more likely to reach outcomes.
“Overall, this study shows the promise of using aggregated EHR data to study CKD progression in children. Our data mirrors observations in CKiD that CKD etiology, proteinuria and hypertension augment the risk for CKD progression,” Gluck said. “We additionally identified that age at cohort entry, CKD stage and pediatric medical complexity algorithm score were risk factors. These risk factors may help us to target future comparative effectiveness trials for slowing CKD progression.”
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Gluck CA, et al. Using electronic health record (EHR) data to evaluate kidney function decline in children with CKD. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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