Prospective cohort analyzing risk factors for chronic kidney disease progression in children,
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Jornal de Pediatria (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000500525 |
Resumo: | Abstract Objective: To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors. Methods: This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3-4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model. Results: After a median follow-up of 2.5 years (IQR = 1.4-3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR = 2.16, CI = 1.14-4.09), nephrotic proteinuria (HR = 2.89, CI = 1.49-5.62), age (HR = 1.10, CI = 1.01-1.17), systolic blood pressure Z score (HR = 1.36, CI = 1.08-1.70), and anemia (HR = 2.60, CI = 1.41-4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR = 0.25, CI = 0.06-1.00) was detected. Conclusions: As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied. |
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Prospective cohort analyzing risk factors for chronic kidney disease progression in children,Chronic kidney diseaseEpidemiologyRisk factorsProgressive patient carePediatricsAbstract Objective: To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors. Methods: This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3-4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model. Results: After a median follow-up of 2.5 years (IQR = 1.4-3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR = 2.16, CI = 1.14-4.09), nephrotic proteinuria (HR = 2.89, CI = 1.49-5.62), age (HR = 1.10, CI = 1.01-1.17), systolic blood pressure Z score (HR = 1.36, CI = 1.08-1.70), and anemia (HR = 2.60, CI = 1.41-4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR = 0.25, CI = 0.06-1.00) was detected. Conclusions: As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied.Sociedade Brasileira de Pediatria2018-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000500525Jornal de Pediatria v.94 n.5 2018reponame:Jornal de Pediatria (Online)instname:Sociedade Brasileira de Pediatria (SBP)instacron:SBPE10.1016/j.jped.2017.07.015info:eu-repo/semantics/openAccessBelangero,Vera M.S.Prates,Liliane C.Watanabe,AndreiaSchvartsman,Benita S.G.Nussenzveig,PaulaCruz,Natalia A.Abreu,Ana L.S.Paz,Isabel P.Facincani,InaldaMorgantetti,Fernanda E.C.Silva,Andreia O.Andrade,Olberes V.B.Camargo,Maria F.C.Nogueira,Paulo C. Kocheng2018-10-26T00:00:00Zoai:scielo:S0021-75572018000500525Revistahttp://www.jped.com.br/https://old.scielo.br/oai/scielo-oai.php||jped@jped.com.br1678-47820021-7557opendoar:2018-10-26T00:00Jornal de Pediatria (Online) - Sociedade Brasileira de Pediatria (SBP)false |
dc.title.none.fl_str_mv |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
title |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
spellingShingle |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, Belangero,Vera M.S. Chronic kidney disease Epidemiology Risk factors Progressive patient care Pediatrics |
title_short |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
title_full |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
title_fullStr |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
title_full_unstemmed |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
title_sort |
Prospective cohort analyzing risk factors for chronic kidney disease progression in children, |
author |
Belangero,Vera M.S. |
author_facet |
Belangero,Vera M.S. Prates,Liliane C. Watanabe,Andreia Schvartsman,Benita S.G. Nussenzveig,Paula Cruz,Natalia A. Abreu,Ana L.S. Paz,Isabel P. Facincani,Inalda Morgantetti,Fernanda E.C. Silva,Andreia O. Andrade,Olberes V.B. Camargo,Maria F.C. Nogueira,Paulo C. Koch |
author_role |
author |
author2 |
Prates,Liliane C. Watanabe,Andreia Schvartsman,Benita S.G. Nussenzveig,Paula Cruz,Natalia A. Abreu,Ana L.S. Paz,Isabel P. Facincani,Inalda Morgantetti,Fernanda E.C. Silva,Andreia O. Andrade,Olberes V.B. Camargo,Maria F.C. Nogueira,Paulo C. Koch |
author2_role |
author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Belangero,Vera M.S. Prates,Liliane C. Watanabe,Andreia Schvartsman,Benita S.G. Nussenzveig,Paula Cruz,Natalia A. Abreu,Ana L.S. Paz,Isabel P. Facincani,Inalda Morgantetti,Fernanda E.C. Silva,Andreia O. Andrade,Olberes V.B. Camargo,Maria F.C. Nogueira,Paulo C. Koch |
dc.subject.por.fl_str_mv |
Chronic kidney disease Epidemiology Risk factors Progressive patient care Pediatrics |
topic |
Chronic kidney disease Epidemiology Risk factors Progressive patient care Pediatrics |
description |
Abstract Objective: To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors. Methods: This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3-4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model. Results: After a median follow-up of 2.5 years (IQR = 1.4-3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR = 2.16, CI = 1.14-4.09), nephrotic proteinuria (HR = 2.89, CI = 1.49-5.62), age (HR = 1.10, CI = 1.01-1.17), systolic blood pressure Z score (HR = 1.36, CI = 1.08-1.70), and anemia (HR = 2.60, CI = 1.41-4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR = 0.25, CI = 0.06-1.00) was detected. Conclusions: As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-10-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000500525 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000500525 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1016/j.jped.2017.07.015 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Pediatria |
publisher.none.fl_str_mv |
Sociedade Brasileira de Pediatria |
dc.source.none.fl_str_mv |
Jornal de Pediatria v.94 n.5 2018 reponame:Jornal de Pediatria (Online) instname:Sociedade Brasileira de Pediatria (SBP) instacron:SBPE |
instname_str |
Sociedade Brasileira de Pediatria (SBP) |
instacron_str |
SBPE |
institution |
SBPE |
reponame_str |
Jornal de Pediatria (Online) |
collection |
Jornal de Pediatria (Online) |
repository.name.fl_str_mv |
Jornal de Pediatria (Online) - Sociedade Brasileira de Pediatria (SBP) |
repository.mail.fl_str_mv |
||jped@jped.com.br |
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1752122321454235648 |