Few studies have prospectively evaluated the progression of chronic kidney disease (CKD) in children and adolescents, as well as factors associated with progression.
A multicenter observational study conducted as part of the NIH-funded Chronic Kidney Disease in Children study found characterization and modeling of risk factors for CKD progression can be used to predict the extent to which factors such as proteinuria, hypoabluminemia, blood pressure, dyslipidemia and anemia -- either alone or in combination -- would shorten the time to renal replacement therapy or 50% decline in GFR in children with chronic kidney disease.
Bradley Warady, MD is here to discuss chronic kidney disease in children and adolescents.
Predictors of Rapid Progression of Kidney Disease in Children and Adolescents
Featured Speaker:
Learn more about Brad Warady, MD
Bradley Warady, MD
Dr. Warady is Director of the Division of Nephrology at Children’s Mercy and Director of Dialysis and Transplantation. In spring 2015, Dr. Warady was presented with the Henry L. Barnett Award for outstanding teaching and clinical care for children with kidney disease by the American Academy of Pediatrics Section on Nephrology. Dr.Warady’s previous awards include the National Kidney Foundation’s 2013 J. Michael Lazarus Award for enhancing the clinical care of patients on dialysis or with chronic kidney disease (CKD) and the Patrick and Virginia Clune Award of Excellence by the National Kidney Foundation of Kansas and Western Missouri. Dr.Warady is Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. His major areas of research are chronic kidney disease and end-stage renal disease (ESRD) management of children. He is the senior editor of two leading books in the field, “Pediatric Dialysis” and “Pediatric Dialysis Case Studies.” He is also Co-Principal Investigator of the NIH funded “Chronic Kidney Disease in Children (CKiD) Study”, the largest study of CKD in children ever conducted in North America.Learn more about Brad Warady, MD
Transcription:
Predictors of Rapid Progression of Kidney Disease in Children and Adolescents
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is Predictors of Rapid Progression of Kidney Disease in Children and Adolescents. My guest is Dr. Bradley Warady. Dr. Warady is a Professor of Pediatrics at the University of Missouri, Kansas City School of Medicine. His major areas of research are chronic kidney disease and end stage renal disease management of children. Dr. Warady, welcome to the show.
Dr. Bradley Warady (Guest): Thank you.
Dr. Smith: Let’s start with a quick overview of the chronic kidney disease in children cohort--what the study is and what we’ve learned so far from the study.
Dr. Warady: Sure. The Chronic Kidney Disease in Children Study or so called CKiD is a study of children with chronic kidney disease or impaired kidney function, pre-dialysis, pre-transplant and what we’ve done in this study that is funded by The National Institutes of Health is collect a lot of longitudinal information from nearly 900 children from around the country with chronic kidney disease. These subjects have been enrolled at 54 different pediatric kidney sites, again, around the country. The goal of the study is to look at factors that might influence the worsening of kidney function over time. Note: As of January 2018, the number of children has grown to nearly 900.
Dr. Smith: How does what we learned from the study impact treatment?
Dr. Warady: The study has been interesting in that in following these children for an average of about a five year period of time – these are children who entered the study between even one year of age and 16 years of age – we found that there are several factors that lead to worsening of the kidney function. They include protein loss in the urine, high blood pressure and anemia or a low red blood cell count. These are factors that seem to be associated with progression of the chronic kidney disease. Most importantly, is that these are all what we would call “potentially modifiable factors”. These are factors that we can treat and the goal would be to treat these factors in an effective manner to see if, in fact, it has an impact on slowing the progression of chronic kidney disease in these children.
Dr. Smith: What are the next steps with the study?
Dr. Warady: In this study, as I think as we just suggested about treatment, that’s really is what our goal is. Our goal now is to work with the NIH to facilitate a better understanding of the impact of treatment. What we hope to do is to work with all the children in this study and all the centers that are participating in the study to aggressively manage their anemia, aggressively manage their high blood pressure and to use medications to decrease protein loss through the kidney to see if, in fact, those interventions will slow the course of their kidney disease. This will really be a proof of concept kind of approach because we have identified the factors in terms of their association, now we have to see if we actually can correct those factors and will it, in fact, lead to a slowing of progression or even a complete stoppage of progression of chronic kidney disease. This would have a huge impact on children in terms of decreasing the numbers of kids and the percentage of kids who go on to require dialysis or transplantation.
Dr. Smith: Now, you personally and Children’s Mercy are really recognized as national leaders in this type of research including pediatric dialysis, transplant care – I think ranked top five by U.S. News. Tell me about the role of this type of research at Children’s Mercy.
Dr. Warady: What we try to do at Children’s Mercy is to look at children, not only in Kansas City where we’re at, but really look at them globally and try to look at what are the major factors that influence the outcome of children who require dialysis or require transplant. Many people really don’t recognize the fact that even young children, even as young as newborns, sometimes have such severe kidney disease that they require dialysis just to sustain their life until a transplant can be achieved. We’re always trying to optimize these therapies. One of the major complications of dialysis in children is infection and we are one of the leaders of a national collaborative to look at the means by which we might decrease the risk of infection in children on dialysis. At the same time, we’re doing research on looking at better ways to match donors and recipients for transplant with the hope of decreasing the failure rate of kidney transplant and, again, prolonging the lifetime of those with a kidney transplant when they occur. So, we’re doing things, again, to try to optimize the long term outcomes both for the dialysis patients and the transplant recipients.
Dr. Smith: Dr. Warady, I want to thank you so much for coming on. I appreciate the time and the work that you’re doing. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Have a great day.
Predictors of Rapid Progression of Kidney Disease in Children and Adolescents
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is Predictors of Rapid Progression of Kidney Disease in Children and Adolescents. My guest is Dr. Bradley Warady. Dr. Warady is a Professor of Pediatrics at the University of Missouri, Kansas City School of Medicine. His major areas of research are chronic kidney disease and end stage renal disease management of children. Dr. Warady, welcome to the show.
Dr. Bradley Warady (Guest): Thank you.
Dr. Smith: Let’s start with a quick overview of the chronic kidney disease in children cohort--what the study is and what we’ve learned so far from the study.
Dr. Warady: Sure. The Chronic Kidney Disease in Children Study or so called CKiD is a study of children with chronic kidney disease or impaired kidney function, pre-dialysis, pre-transplant and what we’ve done in this study that is funded by The National Institutes of Health is collect a lot of longitudinal information from nearly 900 children from around the country with chronic kidney disease. These subjects have been enrolled at 54 different pediatric kidney sites, again, around the country. The goal of the study is to look at factors that might influence the worsening of kidney function over time. Note: As of January 2018, the number of children has grown to nearly 900.
Dr. Smith: How does what we learned from the study impact treatment?
Dr. Warady: The study has been interesting in that in following these children for an average of about a five year period of time – these are children who entered the study between even one year of age and 16 years of age – we found that there are several factors that lead to worsening of the kidney function. They include protein loss in the urine, high blood pressure and anemia or a low red blood cell count. These are factors that seem to be associated with progression of the chronic kidney disease. Most importantly, is that these are all what we would call “potentially modifiable factors”. These are factors that we can treat and the goal would be to treat these factors in an effective manner to see if, in fact, it has an impact on slowing the progression of chronic kidney disease in these children.
Dr. Smith: What are the next steps with the study?
Dr. Warady: In this study, as I think as we just suggested about treatment, that’s really is what our goal is. Our goal now is to work with the NIH to facilitate a better understanding of the impact of treatment. What we hope to do is to work with all the children in this study and all the centers that are participating in the study to aggressively manage their anemia, aggressively manage their high blood pressure and to use medications to decrease protein loss through the kidney to see if, in fact, those interventions will slow the course of their kidney disease. This will really be a proof of concept kind of approach because we have identified the factors in terms of their association, now we have to see if we actually can correct those factors and will it, in fact, lead to a slowing of progression or even a complete stoppage of progression of chronic kidney disease. This would have a huge impact on children in terms of decreasing the numbers of kids and the percentage of kids who go on to require dialysis or transplantation.
Dr. Smith: Now, you personally and Children’s Mercy are really recognized as national leaders in this type of research including pediatric dialysis, transplant care – I think ranked top five by U.S. News. Tell me about the role of this type of research at Children’s Mercy.
Dr. Warady: What we try to do at Children’s Mercy is to look at children, not only in Kansas City where we’re at, but really look at them globally and try to look at what are the major factors that influence the outcome of children who require dialysis or require transplant. Many people really don’t recognize the fact that even young children, even as young as newborns, sometimes have such severe kidney disease that they require dialysis just to sustain their life until a transplant can be achieved. We’re always trying to optimize these therapies. One of the major complications of dialysis in children is infection and we are one of the leaders of a national collaborative to look at the means by which we might decrease the risk of infection in children on dialysis. At the same time, we’re doing research on looking at better ways to match donors and recipients for transplant with the hope of decreasing the failure rate of kidney transplant and, again, prolonging the lifetime of those with a kidney transplant when they occur. So, we’re doing things, again, to try to optimize the long term outcomes both for the dialysis patients and the transplant recipients.
Dr. Smith: Dr. Warady, I want to thank you so much for coming on. I appreciate the time and the work that you’re doing. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Have a great day.