Summary
Chronic kidney disease (CKD) progression is typically characterized as either time
to a clinically meaningful event (such as dialysis or transplant), or longitudinal
changes in kidney function. This review describes pediatric kidney disease progression
using these two distinct frameworks by reviewing and discussing data from the Chronic
Kidney Disease in Children study. We first describe new equations to estimate glomerular
filtration rate (GFR) for patients younger than age 25 years, and how the average
of serum creatinine-based and cystatin C–based GFR equations yield valid estimates
than either alone. Next, we present a life course description of CKD onset to kidney
replacement therapy, prediction models based on clinical measurements, and show the
importance of diagnosis (broadly classified as nonglomerular and glomerular in origin),
GFR level, and proteinuria on progression. Literature on longitudinal GFR in children
and young adults are reviewed and new data are presented to characterize nonlinear
changes in estimated GFR in patients younger than age 25 years. These models showed
accelerated progression associated with glomerular diagnosis, lower GFR level, and
higher proteinuria, which was congruent with time-to-event analyses. Descriptions
of online tools for GFR estimation and risk stratification for clinical applications
are presented and we offer key epidemiologic considerations for the analysis of longitudinal
pediatric CKD studies.
Keywords
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