In children with chronic kidney disease (CKD), the kidney failure risk equation (KFRE) performs well in predicting the risk of progression to end stage renal disease (ESRD), concludes a study in JAMA Pediatrics.
The retrospective analysis included 603 children from a multicenter pediatric CKD cohort study. About 63% of the patients were boys. Their median age at study entry was 12 years and they had a median estimated glomerular filtration rate (eGFR) of 44 mL/min/1.73 m2. Two versions of the KFRE were analyzed for their ability to predict progression to ESRD: a four-variable version (age, sex, bedside Schwartz eGFR, and ratio of albumin to creatinine) and an eight-variable version (the same four variables plus serum calcium, phosphate, bicarbonate, and albumin).
The median follow-up time was 3.8 years. By 5 years, 23.9% of the children had progressed to ESRD. Both versions of the KFRE provided excellent discrimination of ESRD risk. With the four-variable equation, C statistics were 0.90 at 1 year, 0.86 at 2 years, and 0.81 at 5 years.
The C statistics were higher for Hispanic versus non-Hispanic patients and for children less than 12 years versus older patients. Progression to ESRD occurred in 27.9% of children in the top tertile of 2-year KFRE score versus 1.7% in the bottom tertile.
The KFRE has proven a useful guide to clinical decision-making in adults with CKD. The new results show that the KFRE is also a good predictor of risk of progression to ESRD in a large group of children with mainly nonglomerular kidney disease. This simple tool “may provide opportunities to improve the care of children with CKD,” the researchers write [Winnicki E, et al. Use of the kidney failure risk equation to determine the risk of progression to end-stage renal disease in children with chronic kidney disease. JAMA Pediatr 2017; doi:10.1001/jamapediatrics.2017.4083].