The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease |
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| Authors: | Susan L. Furth Jeffrey J. Fadrowski Arlene Gerson Christopher B. Pierce Manju Chandra Robert Weiss Frederick Kaskel The Council of Pediatric Nephrology Urology New York/New Jersey The Kidney Urology Foundation of America |
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| Affiliation: | (1) Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, MD, USA;(2) Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA;(3) The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA;(4) North Shore University Hospital, New York, NY, USA;(5) Maria Fareri Children’s Hospital at Westchester Medical Center, New York, NY, USA;(6) Montefiore Medical Center, Bronx, New York, NY, USA;(7) Departments of Pediatrics and Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical Institutions, 2024 E. Monument Street, Baltimore, MD 21287, USA |
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| Abstract: | We sought to describe rates of kidney function decline and to identify modifiable risk factors for CKD progression in a multicenter prospective cohort study of adolescents with CKD aged 11 to 18 years seen semiannually for up to three years. Of the 23 subjects meeting inclusion criteria, the average estimated GFR was 51 ± 27 ml/min/1.73 m2 (0.85 ± 0.45 ml/s/1.73 m2) at entry. The overall annualized decline in GFR was 5.6 ml/min/1.73 m2 (0.093 ml/s/1.73 m2) per year (95% confidence interval [95% CI]: 1.9 to 9.3 [0.032 to 0.16]). The adjusted annualized decline in GFR was found to be accelerated in males, as well as among those over 15 years of age. The adjusted annualized decline in GFR was greater among those with either anemia (hematocrit below 36%), or hypoalbuminemia (albumin below 4 g/dl [40 g/L]). After adjustment, anemia was associated with an accelerated decline of 7.8 ml/min/1.73 m2 (0.13 ml/s/1.73 m2) (95% CI: 3.3 to 12 [0.055 to 0.20]) and hypoalbuminemia was associated with an accelerated decline of 17 ml/min/1.73 m2 (0.28 ml/s/1.73 m2) (95% CI: 11 to 22 [0.18 to 0.37]). Further study is needed to evaluate whether treatment of anemia or hypoalbuminemia, as outlined in current clinical care guidelines for CKD, may slow the progression of CKD in adolescents. |
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| Keywords: | Pediatrics Chronic kidney disease Progression Anemia Hypoalbuminemia |
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