Hyperuricemia and Progression of CKD in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort Study
| Autor: | George J. Schwartz, Susan L. Furth, Bradley A. Warady, Kyle E. Rodenbach, Donald J. Weaver, Michael F. Schneider, Mark Mitsnefes, Marva Moxey-Mims |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Renal function Hyperuricemia urologic and male genital diseases Essential hypertension Article Cohort Studies chemistry.chemical_compound Internal medicine medicine Humans Longitudinal Studies Prospective Studies Renal replacement therapy Renal Insufficiency Chronic Risk factor Child business.industry medicine.disease Uric Acid Cross-Sectional Studies Endocrinology chemistry Nephrology Disease Progression Uric acid Female business Kidney disease Cohort study |
| Zdroj: | American Journal of Kidney Diseases. 66:984-992 |
| ISSN: | 0272-6386 |
| DOI: | 10.1053/j.ajkd.2015.06.015 |
| Popis: | Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children.Prospective observational cohort study.Children and adolescents (n=678 cross-sectional; n=627 longitudinal) with a median age of 12.3 (IQR, 8.6-15.6) years enrolled at 52 North American sites of the CKiD (CKD in Children) Study.Serum uric acid level (5.5, 5.5-7.5, and7.5mg/dL).Composite end point of either30% decline in glomerular filtration rate (GFR) or initiation of renal replacement therapy.Age, sex, race, blood pressure status, GFR, CKD cause, urine protein-creatinine ratio (0.5, 0.5-2.0, and ≥2.0mg/mg), age- and sex-specific body mass index95th percentile, use of diuretics, and serum uric acid level.Older age, male sex, lower GFR, and body mass index95th percentile were associated with higher uric acid levels. 162, 294, and 171 participants had initial uric acid levels5.5, 5.5 to 7.5, or7.5 mg/dL, respectively. We observed 225 instances of the composite end point over 5 years. In a multivariable parametric time-to-event analysis, compared with participants with initial uric acid levels 5.5mg/dL, those with uric acid levels of 5.5 to 7.5 or7.5mg/dL had 17% shorter (relative time, 0.83; 95% CI, 0.62-1.11) or 38% shorter (relative time, 0.62; 95% CI, 0.45-0.85) times to event, respectively. Hypertension, lower GFR, glomerular CKD cause, and elevated urine protein-creatinine ratio were also associated with faster times to the composite end point.The study lacked sufficient data to examine how use of specific medications might influence serum uric acid levels and CKD progression.Hyperuricemia is a previously undescribed independent risk factor for faster progression of CKD in children and adolescents. It is possible that treatment of children and adolescents with CKD with urate-lowering therapy could slow disease progression. |
| Databáze: | OpenAIRE |
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