Division of Nephrology, Department of Pediatrics, University of California, San Francisco.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
JAMA Pediatr. 2018 Feb 1;172(2):174-180. doi: 10.1001/jamapediatrics.2017.4083.
The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with chronic kidney disease (CKD). Use of the KFRE in children with CKD, if accurate, would help to optimize planning for end-stage renal disease (ESRD) care.
To determine whether the KFRE adequately discriminates the risk of ESRD in children with CKD.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 603 children with an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 in the Chronic Kidney Disease in Children study, a national multicenter observational study. Data were collected from January 1, 2005, through July 31, 2013, and analyzed from September 30, 2016, through September 8, 2017.
The primary predictive factors were the 4-variable (age, sex, bedside Schwartz estimated glomerular filtration rate, and ratio of albumin to creatinine levels) and 8-variable (4 variables plus serum calcium, phosphate, bicarbonate, and albumin levels) KFREs, which provide 1-, 2-, and 5-year estimates of the risk of progression to ESRD.
Time to ESRD. The Cox proportional hazards model was used to examine the association between the KFRE score and time to ESRD. C statistics were used to discriminate ESRD risk by the KFRE, with a value of greater than 0.80 indicating strong discrimination.
Of the 603 children included in the study, 378 were boys (62.7%) and 225 were girls (37.3%); median age at study entry was 12 years (interquartile range, 8-15 years). Median estimated glomerular filtration rate was 44 mL/min/1.73 m2. Four hundred fifty-seven participants (75.8%) had a nonglomerular cause of CKD. Median observation time was 3.8 years (interquartile range, 1.7-6.2 years); 144 (23.9%) developed ESRD within 5 years of enrollment. The 4-variable KFRE scores discriminated risk of ESRD, with C statistics of 0.90, 0.86, and 0.81 for the 1-, 2-, and 5-year risk scores, respectively. Results were similar using the 8-variable equation.
The KFRE is a simple tool that provides excellent discrimination of the risk of ESRD. Results suggest that the KFRE could be incorporated into the clinical care of children with CKD to aid in anticipatory guidance, timing of referral for transplant evaluation, and planning for dialysis access.
已证明肾脏衰竭风险方程 (KFRE) 能够准确估计慢性肾脏病 (CKD) 成人患者进展为肾衰竭的风险。如果 KFRE 在 CKD 儿童中使用准确，将有助于优化终末期肾病 (ESRD) 护理的规划。
确定 KFRE 是否能充分区分 CKD 儿童发生 ESRD 的风险。
设计、地点和参与者： 这项回顾性队列研究纳入了慢性肾脏病儿童研究中的 603 名估计肾小球滤过率 (eGFR) 低于 60mL/min/1.73m2 的儿童，这是一项全国多中心观察性研究。数据收集于 2005 年 1 月 1 日至 2013 年 7 月 31 日，分析于 2016 年 9 月 30 日至 2017 年 9 月 8 日进行。
主要预测因素为 4 变量（年龄、性别、床边 Schwartz 估计肾小球滤过率和白蛋白与肌酐比值）和 8 变量（4 变量加血清钙、磷、碳酸氢盐和白蛋白水平）KFRE，它们提供了 1、2 和 5 年进展为 ESRD 的风险估计。
ESRD 发生时间。Cox 比例风险模型用于检验 KFRE 评分与 ESRD 发生时间之间的关系。C 统计量用于通过 KFRE 区分 ESRD 风险，C 统计量大于 0.80 表示具有较强的区分能力。
研究共纳入 603 名儿童，其中 378 名男性（62.7%），225 名女性（37.3%）；研究入组时的中位年龄为 12 岁（四分位距，8-15 岁）。中位 eGFR 为 44mL/min/1.73m2。457 名参与者（75.8%）患有非肾小球性 CKD。中位观察时间为 3.8 年（四分位距，1.7-6.2 年）；144 名（23.9%）在入组后 5 年内发生 ESRD。4 变量 KFRE 评分可区分 ESRD 风险，其 1、2 和 5 年风险评分的 C 统计量分别为 0.90、0.86 和 0.81。使用 8 变量方程得到的结果相似。
KFRE 是一种简单的工具，可提供出色的 ESRD 风险区分能力。结果表明，KFRE 可纳入 CKD 儿童的临床护理中，以帮助提供预期指导、确定移植评估的转诊时机以及规划透析通路。
