Risk Equation Predicts Outcomes in Pediatric CKD

Full access

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].