Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program
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ORIGINAL ARTICLE
Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program Cristina M. Bouissou Soares & José Silvério S. Diniz & Eleonora M. Lima & Jose M. Penido Silva & Gilce R. Oliveira & Monica R. Canhestro & Enrico A. Colosimo & Ana Cristina Simoes e Silva & Eduardo A. Oliveira
Received: 16 November 2007 / Revised: 4 April 2008 / Accepted: 10 April 2008 / Published online: 17 June 2008 # IPNA 2008
Abstract The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan–Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38–145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m2 body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m2 per year (IQ range −24 to −5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, C. M. B. Soares : J. S. S. Diniz : E. M. Lima : J. M. P. Silva : G. R. Oliveira : M. R. Canhestro : A. C. Simoes e Silva : E. A. Oliveira Pediatric Nephrourology Unit, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil E. A. Colosimo Department of Statistics, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil E. A. Oliveira (*) Rua Engenheiro Amaro Lanari 389/501, Belo Horizonte, Minas Gerais 30.310.580, Brazil e-mail: [email protected]
and miscellanea were 2.5 ml/min (IQ range −10 to +0.34), 2.2 ml/min (IQ range −5.0 to −0.52), and 0.36 ml/min (IQ range −2.5 to +2.6), respectively (P 2 mg/mg). Weightfor-age (WAZ) and height-for-age (HAZ) z scores were used to assess weight and stature, respectively. These parameters were calculated with the public domain software Epi Info
Pediatr Nephrol (2008) 23:2039–2046
(version 3.4.1) provided on the World Wide Web by the Centers for Disease Control (CDC), Atlanta, USA [14]. Clinical protocol After the initial investigation, patients were followed according to a systematic protocol. The visits were scheduled periodically at intervals of approximately 3 months, and a complete examination was performed on each occasion and included measurement of blood pressure, height, and weight. Laboratory evaluation was performed at approximately 3-month intervals, depending on the clinical condition of each patient. Psychological examination was also scheduled, as needed by
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