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Am J Kidney Dis. 2018 May;71(5):648-656. doi: 10.1053/j.ajkd.2017.08.013. Epub 2017 Nov 11.

Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study.

Author information

1
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu.
2
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA.
3
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
4
Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO.
5
Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
6
Division of Pediatric Nephrology, Department of Pediatrics, Rady Children's Hospital, La Jolla, CA.
7
Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.

Abstract

BACKGROUND:

Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD).

STUDY DESIGN:

Observational cohort study.

SETTING & PARTICIPANTS:

We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study.

PREDICTORS:

Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models.

OUTCOMES:

Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models.

RESULTS:

During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1).

LIMITATIONS:

Observational nature of our study, lack of longitudinal assessments of inflammatory markers.

CONCLUSIONS:

In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.

KEYWORDS:

BMI trajectory; Body mass index (BMI); CKD progression; adolescents; children; chronic kidney disease (CKD); end-stage renal disease (ESRD); growth; height; malnutrition; pediatric CKD; weight loss

PMID:
29132947
PMCID:
PMC5916028
[Available on 2019-05-01]
DOI:
10.1053/j.ajkd.2017.08.013

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