estimated glomerular filtration rate and hydronephrosis in ... · rate and hydronephrosis in...
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Estimated Glomerular Filtration Rate and Hydronephrosis in Patients with Spina Bifida
David I. Chu, Lauren C. Balmert, Liqi Chen, Cameron Arkin, Theresa Meyer, Ilina Rosoklija, Diana K. Bowen, Kavita S. Hodgkins, Earl Y. Cheng, Tamara Isakova, Elizabeth B. Yerkes
Fall Congress 2019 @DaveIChu
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Disclosure
• None
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Spina Bifida (SB) and Chronic Kidney Disease (CKD)
Blok 2018, Groen 2016, Bauer 2012, Radmyr 2018, Kavanagh 2019, Agrawal 2019
Goal: preserve kidney function
Renal ultrasound for hydronephrosis
Calculateestimated GFR (eGFR)
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Which kidney function assessment tool to use?
eGFR equations Renal ultrasound(RUS)
Chu 2019
?
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Overall Study Goal
To determine association between
eGFR and hydronephrosis
in young patients with spina bifida.
Hypothesis: Lower eGFR values will be associated with higher odds of hydronephrosis.
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Study Design and Participants
Cohort: Lurie Children’s Hospital Spina Bifida ClinicAge range = 0-35 years
Eligibility: Full eGFR data + RUS within 6 months; 2 kidneys
Study Period: 2012-2017
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Variables
Outcome: Hydronephrosis (any SFU >0)
Covariates: age, gender, myelomeningocele (MM) vs non-MM, ambulatory status, CIC-dependency, prior bladder augmentation
Predictor: eGFR (calculated from 6 pediatric equations and 5 adult equations)
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Six Pediatric eGFR Equations (1-18 years old)
Pediatric eGFR equation Creatinine, Cystatin-C, or both Height used?
Bedside Schwartz Creatinine yes
Cystatin-C Schwartz Cystatin-C no
CKiD Both yes
Zappitelli Both yes
FAS-age Creatinine no
FAS-height Creatinine yes
Schwartz 2009, Schwartz 2012, Zappitelli 2006, Pottel 2016
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Five Adult eGFR Equations (>18 years old)
Adult eGFR equation Creatinine, Cystatin-C, or both Height used?
CKD-EPI-Cr Creatinine no
CKD-EPI-CysC Cystatin-C no
CKD-EPI-both Both no
FAS-age Creatinine no
FAS-height Creatinine yes
Levey 2009, Inker 2012, Pottel 2016
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Cohort Characteristics
Age, yearsmedian (IQR)
Female MM Non-ambul.
CIC Bladderaug.
Childrenn=177
10.4(6.7, 14.1)
58% 80% 32% 81% 19%
Adultsn=71
21.8 (19.9, 23.6)
56% 83% 32% 89% 14%
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Cohort Characteristics
Age, yearsmedian (IQR)
Female MM Non-ambul.
CIC Bladderaug.
Hydro?
Childrenn=177
10.4(6.7, 14.1)
58% 80% 32% 81% 19% 20%
Adultsn=71
21.8 (19.9, 23.6)
56% 83% 32% 89% 14% 25%
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Children: More eGFR<90 if +hydro compared to -hydro
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1-66% of children without hydronephrosis had low eGFR
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Adults: More eGFR<90 if +hydro compared to -hydro
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0-17% of adults without hydronephrosis had low eGFR
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Per 10-unit eGFR decrease, higher odds of hydronephrosis
Children: Odds Ratios 1.2-2.3 Adults: Odds Ratios 1.1-1.5
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Discussion and Limitations
Limitation: Lacking gold-standard GFR
No hydro may miss low eGFR
Worse eGFR is associated with hydro
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Conclusion
RUS alone insufficient for CKD surveillance
Check multiple eGFR equations AND RUS