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Clin J Am Soc Nephrol. 2019 Oct 3. pii: CJN.04350419. doi: 10.2215/CJN.04350419. [Epub ahead of print]

Survival and Kidney Outcomes of Children with an Early Diagnosis of Posterior Urethral Valves.

Author information

1
Department of Research, kherbst@connecticutchildrens.org.
2
Division of Urology, and.
3
Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut.
4
Division of Nephrology, Connecticut Children's Medical Center, Hartford, Connecticut.
5
Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and.
6
Department of Research.
7
Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas.

Abstract

BACKGROUND AND OBJECTIVES:

Posterior urethral valve is the most common cause of bladder outlet obstruction in infants. We aimed to describe the rate and timing of kidney-related and survival outcomes for children diagnosed with posterior urethral valves in United States children's hospitals using the Pediatric Health Information System database.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

This retrospective cohort study included children hospitalized between January 1, 1992 and December 31, 2006, who were in their first year of life, had a diagnosis of congenital urethral stenosis, and underwent endoscopic valve ablation or urinary drainage intervention, or died. Records were searched up to December 31, 2018 for kidney-related mortality, placement of a dialysis catheter, and kidney transplantation. Cox regression analysis was used to identify risk factors, and Kaplan-Meier survival analysis used to determine time-to-event probability. Subgroup survival analysis was performed with outcomes stratified by the strongest identified risk factor.

RESULTS:

Included were 685 children hospitalized at a median age of 7 (interquartile range, 1-37) days. Thirty four children (5%) died, over half during their initial hospitalization. Pulmonary hypoplasia was the strongest risk factor for death (hazard ratio, 7.5; 95% confidence interval [95% CI], 3.3 to 17.0). Ten-year survival probability was 94%. Fifty-nine children (9%) underwent one or more dialysis catheter placements. Children with kidney dysplasia had over four-fold risk of dialysis catheter placement (hazard ratio, 4.6; 95% CI, 2.6 to 8.1). Thirty-six (7%) children underwent kidney transplant at a median age of 3 (interquartile range, 2-8) years. Kidney dysplasia had a nine-fold higher risk of kidney transplant (hazard ratio, 9.5; 95% CI, 4.1 to 22.2).

CONCLUSIONS:

Patients in this multicenter cohort with posterior urethral valves had a 5% risk of death, and were most likely to die during their initial hospitalization. Risk of death was higher with a diagnosis of pulmonary hypoplasia. Kidney dysplasia was associated with a higher risk of need for dialysis/transplant.

PODCAST:

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_10_03_CJN04350419.mp3.

KEYWORDS:

ESRD; United States; child; children; chronic renal disease; clinical nephrology; dialysis; humans; infant; kidney transplantation; mortality; mortality risk; obstructive uropathy; outcomes; pediatric kidney transplantation; pediatric nephrology; progression of renal failure; renal agenesis; renal dialysis; renal failure; renal function; renal progression; risk factors; survival; transplant outcomes

PMID:
31582461
DOI:
10.2215/CJN.04350419

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