Ng Derek K, Xu Yunwen, Hogan Julien, Saland Jeffrey M, Greenbaum Larry A, Furth Susan L, Warady Bradley A, Wong Craig S
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Emory Transplant Center, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA.
Pediatr Nephrol. 2020 Oct;35(10):1925-1933. doi: 10.1007/s00467-020-04542-2. Epub 2020 May 3.
Preparing children with chronic kidney disease (CKD) for renal replacement therapy (RRT) begins with a discussion about transplant and dialysis, but its typical timing in the course of CKD management is unclear. We aimed to describe participant-reported RRT planning discussions by CKD stage, clinical and sociodemographic characteristics, in the Chronic Kidney Disease in Children (CKiD) cohort.
Participants responded to the question "In the past year, have you discussed renal replacement therapy with your doctor or healthcare provider?" at annual study visits. Responses were linked to the previous year CKD risk stage based on GFR and proteinuria. Repeated measure logistic models estimated the proportion discussing RRT by stage, with modification by sex, age, race, socioeconomic status, and CKD diagnosis (glomerular vs. non-glomerular).
A total of 721 CKiD participants (median age = 12, 62% boys) contributed 2856 person-visits. Proportions of person-visits reporting RRT discussions increased as CKD severity increased (10% at the lowest disease stage and 87% at the highest disease stage). After controlling for CKD risk stage, rates of RRT discussions did not differ by sex, age, race, and socioeconomic status.
Despite participant-reported RRT discussions being strongly associated with CKD severity, a substantial proportion with advanced CKD reported no discussion. While recall bias may lead to underreporting, it is still meaningful that some participants with severe CKD did not report or remember discussing RRT. Initiating RRT discussions early in the CKD course should be encouraged to foster comprehensive preparation and to align RRT selection for optimal health and patient preferences.
为患有慢性肾脏病（CKD）的儿童准备肾脏替代治疗（RRT）始于关于移植和透析的讨论，但其在CKD管理过程中的典型时机尚不清楚。我们旨在按CKD阶段、临床和社会人口统计学特征，描述儿童慢性肾脏病（CKiD）队列中参与者报告的RRT规划讨论情况。
参与者在年度研究访视时回答问题“在过去一年里，你是否与你的医生或医疗服务提供者讨论过肾脏替代治疗？”。根据肾小球滤过率（GFR）和蛋白尿将回答与上一年的CKD风险阶段相关联。重复测量逻辑模型估计按阶段讨论RRT的比例，并根据性别、年龄、种族、社会经济地位和CKD诊断（肾小球性与非肾小球性）进行修正。
共有721名CKiD参与者（中位年龄 = 12岁，62%为男孩）贡献了2856人次访视。报告RRT讨论的人次比例随着CKD严重程度的增加而增加（疾病最轻阶段为10%，最重阶段为87%）。在控制了CKD风险阶段后，RRT讨论率在性别、年龄、种族和社会经济地位方面没有差异。
尽管参与者报告的RRT讨论与CKD严重程度密切相关，但相当一部分晚期CKD患者报告未进行讨论。虽然回忆偏倚可能导致报告不足，但一些重度CKD患者未报告或不记得讨论过RRT仍然值得关注。应鼓励在CKD病程早期开展RRT讨论，以促进全面准备，并使RRT选择与最佳健康状况和患者偏好相匹配。
