Indicator Details — Children and Adolescents: Percentage of Pediatric CKD Patients with Proteinuria by ACE Inhibitor/ARB Use and Glomerular Diseasea
Data Sources
 
Stratification and Year Choices:
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  Source
  • CKiD

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  • Proteinuria, ACE/ARB Use
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Footnotes:
a Proteinuria was defined by the urinary protein/creatinine ratio (Up/c) as: normal, Up/c<0.2; significant, Up/c 0.2-2; and nephrotic (=consistent with kidney disease), Up/c>2. ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker. Adapted from Wong et al. (2009).




Overall, 54% of pediatric CKD patients were on ACE inhibitors or ARBs; 80% of those with a glomerular diagnosis were on these medications.

These medications were associated with less severe proteinuria among those with glomerular diagnoses.
Chart Explanation: Overall, 54% of pediatric CKD patients were on ACE inhibitors or ARBs; 80% of those with a glomerular diagnosis were on these medications. Among those with glomerular diagnoses, nephrotic proteinuria, or severe proteinuria consistent with kidney disease, was seen in 23% of those on ACE inhibitors/ARBs; the same severity of proteinuria was seen in 67% of those not on these medications. These associations remained after adjustment for kidney function in the form of measured GFR (not shown in figure).
The Chronic Kidney Disease in Children (CKiD) study is a prospective observational study of an estimated 500 children (1-16 years old) at 48 North American centers with varying degrees of CKD severity, which was designed to measure consequences in pediatric CKD patients. As with all cohort studies, recruitment bias and lack of representativeness may influence estimates.

Analyses for this measure were restricted to the 419 children enrolled in CKiD with measured iohexol GFR and proteinuria (urine protein/creatinine or Up/c ratio) as well as known gender, age, CKD diagnosis and current medication use. Complete methods can be found in Wong et al. (2009).
FieldData
Description of MeasureAppropriate treatment of proteinuria among children with CKD
Data SourceCKiD prospective observational cohort study
Type of Data SourcePrivate
Data SetCKiD summarized data
Health Care System DataNo
Regional or National?National
Demographic GroupChildren (1-16 years old) with mild to moderate CKD (Schwartz-estimated GFR of 30-90 ml/min/1.73 m²) who are treated throughout 48 pediatric nephrology centers in North America (46 U.S., 2 Canadian centers)
NumeratorEnrolled children with abnormal protein/creatinine (Up/c) ratio and with measured iohexol GFR as well as known gender, age, CKD diagnosis and current medication use
DenominatorEnrolled children with measured iohexol GFR and proteinuria (urine protein/creatinine or Up/c ratio) as well as known gender, age, CKD diagnosis and current medication use
Definition of CKDSchwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)
Glomerular filtration rateMeasured, by iohexol
ProteinuriaNormal, Up/c<0.2; significant, Up/c 0.2-2; and nephrotic, Up/c>2
Primary Data Source IndicatorCurrent medication use
Primary Indicator Method of MeasurementSelf-report (interview)
Secondary (1) VariableUp/c
Secondary (1) Indicator Method of MeasurementMeasured at central lab (University of Rochester) from 1st-morning urine samples
Secondary (2) VariableGFR
Secondary (2) Indicator Method of MeasurementMeasured by plasma iohexol disappearance curves (iGFR)
Frequency of Measurement (Primary)At all scheduled visits; only baseline presented
U.S. Region Covered by Primary VariableAll
Period Currently Available2004–2008
Pending DataNone for baseline; further visits scheduled
Additional Data Items of InterestStage of CKD, stratification variables of interest (age, gender, race/ethnicity )
Limitations of IndicatorError in medication self-report; some urine samples may not be 1st morning; not all patients had iGFR measured
Analytical ConsiderationsData summarized by CKiD investigators (see Wong et al.); as with all cohort studies, selection bias and possible confounding
References and Sources:
  • Wong CS, Pierce CB, Cole SR, et al. Association of Proteinuria with Race, Cause of Chronic Kidney Disease, and Glomerular Filtration Rate in the Chronic Kidney Disease in Children Study. Clinical Journal of the American Society of Nephrology : CJASN. 2009;4(4):812-819.
    https://www.ncbi.nlm.nih.gov/pubmed/19297612
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd