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Identifying children at increased risk of chronic kidney disease progression

A new study has described different trajectories of chronic kidney disease (CKD) progression in children that will aid in identifying those at high risk for progressive disease. The basic functional unit of the kidney is the nephron, which consists of various cells and structures that work together to filter waste products, remove excess fluid from the blood, and balance various body chemicals. Of these structures, the glomerulus is the fundamental filtering apparatus. A common kidney function measurement called the glomerular filtration rate (GFR) is an estimate of blood filtered per minute by all the nephrons within the kidneys. The ability to predict CKD progression, as measured by declining GFR, is a major challenge for nephrology (the medical specialty focused on the kidneys).

Using publicly available Chronic Kidney Disease in Children (CKiD) study data through the NIDDK Central Repository, researchers employed a statistical modeling approach to establish GFR trajectories (i.e., changes in kidney function over time) in female and male participants with glomerular and non- glomerular diseases. CKiD is a multi-center study of children ages 1 to 16 years with mildly to moderately impaired kidney function. The CKiD researchers are monitoring the health of these children over time in several areas, including determining the risk factors for decline in kidney function, and defining how progressive decline in kidney function affects biomarkers of risk factors for cardiovascular disease, evaluating several brain functions (e.g., attention, perception, memory, language, and behavior), and assessing growth failure and its associated morbidity. Using data from CKiD, this study found two distinct GFR trajectories for glomerular disease while four distinct GFR trajectories were reported for non- glomerular disease. Glomerular and non-glomerular diseases displayed very different GFR trajectories— among those with glomerular disease, a subset of female participants had a rapid GFR trajectory decline indicating rapid loss of kidney function, whereas no difference was observed between sexes in those with non-glomerular diseases.

This valuable new information from a subset of girls with rapidly progressing glomerular disease will enable clinicians to better prepare their patients and their families for kidney transplantation or dialysis. Furthermore, girls have lower access to kidney transplantation in the United States than boys, and this study could help address this disparity.

Bonnéric S, Karadkhele G, Couchoud C, Patzer RE, Greenbaum LA, and Hogan J. Sex and glomerular filtration rate trajectories in children. Clin J Am Soc Nephrol 15: 320-329, 2020.