Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
Pediatr Nephrol. 2021 Jan;36(1):111-118. doi: 10.1007/s00467-020-04661-w. Epub 2020 Jun 25.
Obstructive uropathy (OU) is a leading cause of pediatric kidney injury. Accurate prediction of kidney disease progression may improve clinical outcomes. We aimed to examine discrimination and accuracy of a validated kidney failure risk equation (KFRE), previously developed in adults, in children with OU.
We identified 118 children with OU and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m in the Chronic Kidney Disease in Children study, a national, longitudinal, observational cohort. Each patient's 5-year risk of kidney failure was estimated using baseline data and published parameters for the 4- and 8-variable KFREs. Discriminative ability of the KFRE was estimated using the C statistic for time-to-event analysis. Sensitivity and specificity were evaluated across varying risk thresholds.
Among the 118 children, 100 (85%) were boys, with median baseline age of 10 years (interquartile range, 6-14). Median eGFR was 42 mL/min/1.73m (32-53), with a median follow-up duration of 4.5 years (2.7-7.2); 23 patients (19.5%) developed kidney failure within 5 years. The 4-variable KFRE discriminated kidney failure risk with a C statistic of 0.75 (95% CI, 0.68-0.82). A 4-variable risk threshold of ≥ 30% yielded 82.6% sensitivity and 75.0% specificity. Results were similar using the 8-variable KFRE.
In children with OU, the KFRE discriminated the 5-year risk of kidney failure at C statistic values lower than previously published in adults but comparable with suboptimal values reported in the overall CKiD population. The 8-variable equation did not improve model discrimination or accuracy, suggesting the need for continued research into additional, disease-specific markers.
梗阻性尿路病（OU）是小儿肾损伤的主要原因。准确预测肾脏疾病的进展可能会改善临床结果。我们旨在研究先前在成人中开发的肾衰竭风险方程（KFRE）在 OU 患儿中的区分度和准确性。
我们在慢性肾脏病儿童研究中确定了 118 例 OU 患儿和肾小球滤过率（eGFR）<60 mL/min/1.73 m 的患儿，这是一个全国性的、纵向的、观察性队列。使用基线数据和已发表的 4 变量和 8 变量 KFRE 参数估计每位患者 5 年内肾衰竭的风险。使用时间事件分析的 C 统计量评估 KFRE 的区分能力。评估了不同风险阈值下的敏感性和特异性。
在 118 例患儿中，100 例（85%）为男孩，中位基线年龄为 10 岁（四分位距，6-14）。中位 eGFR 为 42 mL/min/1.73 m（32-53），中位随访时间为 4.5 年（2.7-7.2）；23 例（19.5%）在 5 年内发生肾衰竭。4 变量 KFRE 的 C 统计量为 0.75（95%CI，0.68-0.82），区分肾衰竭风险。4 变量风险阈值≥30%时，敏感性为 82.6%，特异性为 75.0%。使用 8 变量 KFRE 时，结果相似。
在 OU 患儿中，KFRE 的 C 统计量值低于先前在成人中发表的值，但与 CKiD 总体人群中报告的次优值相当，从而区分 5 年内肾衰竭的风险。8 变量方程并没有提高模型的区分度或准确性，这表明需要继续研究其他特定疾病的标志物。
