Authors: Alison G Abraham Aisha Betoko Jeffrey J Fadrowski Christopher Pierce Susan L Furth Bradley A Warady Alvaro Muñoz
Publish Date: 2016/11/08
Volume: 32, Issue: 4, Pages: 643-649
Abstract
Clinical care decisions to treat chronic kidney disease CKD in a growing child must often be made without the benefit of evidence from clinical trials We used observational data from the Chronic Kidney Disease in Children cohort to estimate the effectiveness of renin–angiotensin II–aldosterone system blockade RAAS to delay renal replacement therapy RRT in children with CKDA total of 851 participants median age 11 years median glomerular filtration rate GFR 52 ml/min/173 m2 median urine protein to creatinine ratio 035 mg/mg were included RAAS use was reported at annual study visits Both Cox proportional hazards models with timevarying RAAS exposure and Cox marginal structural models MSM were used to evaluate the effect of RAAS use on time to RRT Analyses were adjusted or weighted to control for age male sex glomerular diagnosis GFR nephrotic range proteinuria anemia elevated blood pressure acidosis elevated phosphate and elevated potassiumThere were 217 RRT events over a 41year median followup At baseline 472 children 55 were prevalent RAAS users who were more likely to be older have a glomerular etiology have higher urine protein be anemic have elevated serum phosphate and potassium take more medications but less likely to have elevated blood pressure compared with nonusers RAAS use was found to reduce the risk of RRT by 21 hazard ratio 079 to 37 hazard ratio 063 from standard regression adjustment and MSM models respectivelyThe authors acknowledge the contributions of all investigators and coordinators in the CKiD Study wwwstatepijhsphedu/ckid in addition to all participating patients and their families Data in this manuscript were collected by the CKiD prospective cohort study with clinical coordinating centers principal investigators at the Children’s Mercy Hospital and the University of Missouri–Kansas City Bradley A Warady MD and the Children’s Hospital of Philadelphia Susan Furth MD PhD the Central Biochemistry Laboratory at the University of Rochester Medical Center George J Schwartz MD and the data coordinating center at the Johns Hopkins Bloomberg School of Public Health Alvaro Muñoz PhD The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart Lung and Blood Institute grants U01DK66143 U01DK66174 U01DK082194 and U01DK66116The study design and conduct was approved by the internal review board of each participating center and by an external advisory committee appointed by the National Institutes of Health Written informed consent/assent was obtained from all participants/families according to local requirements
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