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).
| Field | Data |
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| Description of Measure | Appropriate treatment of proteinuria among children with CKD |
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| Data Source | CKiD prospective observational cohort study |
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| Type of Data Source | Private |
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| Data Set | CKiD summarized data |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Children (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) |
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| Numerator | Enrolled 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 |
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| Denominator | Enrolled 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 |
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| Definition of CKD | Schwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study) |
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| Glomerular filtration rate | Measured, by iohexol |
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| Proteinuria | Normal, Up/c<0.2; significant, Up/c 0.2-2; and nephrotic, Up/c>2 |
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| Primary Data Source Indicator | Current medication use |
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| Primary Indicator Method of Measurement | Self-report (interview) |
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| Secondary (1) Variable | Up/c |
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| Secondary (1) Indicator Method of Measurement | Measured at central lab (University of Rochester) from 1st-morning urine samples |
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| Secondary (2) Variable | GFR |
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| Secondary (2) Indicator Method of Measurement | Measured by plasma iohexol disappearance curves (iGFR) |
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| Frequency of Measurement (Primary) | At all scheduled visits; only baseline presented |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 2004–2008 |
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| Pending Data | None for baseline; further visits scheduled |
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| Additional Data Items of Interest | Stage of CKD, stratification variables of interest (age, gender, race/ethnicity ) |
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| Limitations of Indicator | Error in medication self-report; some urine samples may not be 1st morning; not all patients had iGFR measured |
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| Analytical Considerations | Data summarized by CKiD investigators (see Wong et al.); as with all cohort studies, selection bias and possible confounding |
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References and Sources:
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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