Ontology highlight
ABSTRACT: Background
Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD).Study design
Observational cohort study.Setting & participants
We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study.Predictors
Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models.Outcomes
Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models.Results
During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1).Limitations
Observational nature of our study, lack of longitudinal assessments of inflammatory markers.Conclusions
In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.
SUBMITTER: Ku E
PROVIDER: S-EPMC5916028 | biostudies-literature | 2018 May
REPOSITORIES: biostudies-literature
Ku Elaine E Kopple Joel D JD McCulloch Charles E CE Warady Bradley A BA Furth Susan L SL Mak Robert H RH Grimes Barbara A BA Mitsnefes Mark M
American journal of kidney diseases : the official journal of the National Kidney Foundation 20171111 5
<h4>Background</h4>Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD).<h4>Study design</h4>Observational cohort study.<h4>Setting & participants</h4>We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study.<h4>Predictors</h4>Repeated measurements of estimated glomerular filt ...[more]