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CKiD Expansion
The CKiD study was recently approved for an additional five years and $4.7 million of funding, making 20 consecutive years of funding. Historically, when participants developed end-stage disease, they left the study. The next phase of study will focus on the entire spectrum of the disease, starting with early CKiD in infants and following those who progress to kidney failure, requiring dialysis and transplant. Currently, CKiD is enrolling an additional 190 children in the new cohort. The study will attempt to detect abnormalities earlier in the process for more timely interventions.
Featured Speaker:
Learn more about Brad Warady, MD
Brad 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:
CKiD Expansion
Dr. Michael Smith (Host): Alright, so our topic today is the CKiD Study Update. My guest is Dr. Bradley Warady. Dr. Warady is the Pediatric Nephrology Division Director and Director of Dialysis and Transplantation. Dr. Warady, welcome to the show.
Brad Warady, MD (Guest): Good morning.
Host: So, let’s talk first, how about a nice overview of the CKiD Study and why was it developed? What were the objectives? And let’s just kind of review that first. Go ahead.
Dr. Warady: Sure, sure. Well the CKiD study which has been in existence now for more than 15 years; is a study that is comprised of investigators from 54 different pediatric programs around the country. And the goal of the CKiD study was to really gather important data about children with chronic kidney disease, meaning kidney injury but not yet requiring dialysis or transplantation. And what we’ve done over the past 15 years in this study is to learn not only about the risk factors that can lead to worsening of kidney disease in these children; but we’ve also gathered a lot of information about the impact of chronic kidney disease on the growth of these kids, on their brain development and on their risks of heart disease. All important outcomes associated with chronic kidney disease.
Host: Yeah, and so we are kind of – now that’s 15 years that’s been ongoing. I know now, I think you are moving kind of into a new direction with the study. Tell us a little bit about some of the new funding and where the study is heading.
Dr. Warady: Sure. So, the National Institutes of Health which has funded this study, graciously have funded us for an additional five years, which will be twenty years of continuous funding for this study which is really unique in studies funded by the NIH. So, the new aspects of CKiD actually, there’s several new aspects. For one, when we look at the vast majority of children that have entered the study in the past, they were around ten years of age. And so, we really didn’t capture information on our youngest children with chronic kidney disease. Those children who are less than five years of age and believe it or not, there are children that young who already have chronic kidney disease. So, in the new phase of CKiD, we are going to be intensively studying these very young children to see if we can sort of define factors which might allow us to prevent or delay the worsening of kidney disease in these youngest children.
On the other side of the spectrum, historically in CKiD, when children went on to have dialysis or a transplant; they no longer were followed in our study. But in the new phase of CKiD; we are continuing to follow children who are on dialysis and who have been transplanted because a lot of things change in their overall wellbeing during those very important times of their chronic illness and we need to study these so that we can again, hopefully optimize the management of these children of who have gone on to have what we call end-stage kidney disease.
Host: This is a really fascinating study. One of the things that my listeners can do. You can go to the chronic kidney disease in children website. It has all about the CKiD study there and on there, there’s specific study objectives and maybe we can just kind of review what we know about some of these objectives and get your opinion about the future really, for this study. One of the objectives on there is to identify novel and traditional renal disease risk factors to help us understand the progression of chronic kidney disease better. Can you tell us what we have found there through the study?
Dr. Warady: Well to date, we have found a number of risk factors or exposures that lend itself to worsening of the kidney disease. One of the more important ones is high blood pressure. I think many people don’t recognize that even young children can have high blood pressure. And so, high blood pressure in an of itself, can not only lead to the more rapid worsening of kidney function in children; but it can also lead to heart disease. So, that’s an important risk factor. And many children who have kidney disease lose protein in their urine. Typically, the kidney does not lose protein, but in children with kidney disease, you can have protein in the urine and the persistence of protein in the urine can also lead to worsening of kidney disease. And then there’s other factors. Anemia or a low red blood cell count, again, another factor that can lead to progression of chronic kidney disease. So, what we try to find in CKiD are those factors that we call modifiable factors; factors where we can intervene with treatments to hopefully modify the course of chronic kidney disease. And in the CKiD study, we continue to look for these modifiable factors which again, if successfully treated, might improve the outcome for children with chronic kidney disease.
Host: Another objective that you mentioned earlier was understanding or characterizing the impact of a decline in kidney function on neurodevelopment. What have we learned from the CKiD study about that?
Dr. Warady: Well, we’ve learned that children who have chronic kidney disease can have problems with their attention span and with what’s called executive function; being able to make decisions about what to do next in an orderly manner. And so, this is important because if we have children who have these issues going on from a neurocognitive standpoint; oftentimes, that information should be shared with the schools so that the schools can sort of optimize the education of these children so they can be successful and I think in many situations, historically, children who have had these – I don’t want to call them learning disabilities, but challenges if you will, in terms of learning; it’s not been addressed in an aggressive manner in the schools. But I think we know now that many of these children with chronic kidney disease can have these problems and so those kids can work with their own centers to better define these issues that might exist in the children to again, optimize education. And so, this means seeing the psychologist at these centers to pick up on what sometimes can be very subtle abnormalities but can have a huge impact on their learning capacity.
Host: Another objective in the CKiD study was to look at declining kidney function and the affects on overall growth and development. What have we learned from that?
Dr. Warady: Well we have learned certainly, that many of these kids can have short stature and so there’s a multiplicity of factors that influence the growth of children with chronic kidney disease. So, these children have to have a good nutritional status. These children have to have a very normal acid-base status. And both of those factors, nutrition and acid-base control can in fact be abnormal in children with chronic kidney disease. And then we also recognized that in some situations, the use of growth hormone therapy in these children can be extremely, extremely beneficial.
Children with chronic kidney disease don’t have abnormal levels of growth hormone; but the growth hormone levels they have aren’t adequate enough to allow normal growth. And so, some children who have optimized their nutrition, who have optimized their acid-base control should be prescribed growth hormone therapy and in general, will experience a very positive outcome. So, all of these kind of again, pieces of information that we have gathered from CKiD, what we are doing now is putting together this information to share it with their pediatric kidney doctors as well as their pediatricians and their family providers and the families themselves so they understand the complexity of the disorders but that the various interventions that we think are necessary to optimize the care for these kids.
Host: Yeah. With the added funding and the extension of the study for another five years; you’d mentioned one of the populations you are going to look at are the kids who received transplantation are now kind of taken out of the CKiD study in a sense, we are now going to be looking at them. What specifically are you wanting to follow and study in that group?
Dr. Warady: I think one of the most important things in that group study is the issue of cardiovascular or heart disease. When you look at children and adults with chronic kidney disease, or who have gone on to have end-stage kidney disease; cardiac disease is the number one cause of morbidity and mortality, risk of death. And so, we recognize especially in the group that are on dialysis; that’s a period of time when the risk of heart disease is at it’s greatest. And interestingly, if one looks at the studies that are out there; those patients that are between about 18 and 25 or 30 years of age; have been a rather understudied population. So, many of the pediatric studies have stopped when the children are about 18 years of age and then the adult studies that have been done, generally the patients that are enrolled in those studies are more than 30 years of age. So, the CKiD study now and the additional funding, it gives us that opportunity to study this very understudied population. We call them the emerging adults, generally between 19 and 25 years. And so, it’s going to give us sort of an opportunity to fill this information gap that has existed in this population of patients.
Host: Lastly, Dr. Warady, what would you like my listeners to know about the CKiD study and chronic kidney disease in children?
Dr. Warady: Well I think the listeners need to recognize as we said that children can have chronic kidney disease. Children can have high blood pressure. And they need to recognize that when they know of children through acquaintances and the like; who have issues with recurrent kidney infections or they’ve been told they have high blood pressure or their growth doesn’t seem to be quite right; they should recognize that the kidney may be the source of the problem and so, they should visit with their primary care providers and make sure that the providers have assessed the kidney issues. The CKiD study again, is making a lot of new information available to practitioners not only across the country, but around the globe. And so, I’m very optimistic that we will continue to gather more information and we will most definitely continue to improve the care that these kids are being provided.
Host: Dr. Warady, I want to thank you for the work that you are doing and thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to www.childrensmercy.org, that’s www.childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.
CKiD Expansion
Dr. Michael Smith (Host): Alright, so our topic today is the CKiD Study Update. My guest is Dr. Bradley Warady. Dr. Warady is the Pediatric Nephrology Division Director and Director of Dialysis and Transplantation. Dr. Warady, welcome to the show.
Brad Warady, MD (Guest): Good morning.
Host: So, let’s talk first, how about a nice overview of the CKiD Study and why was it developed? What were the objectives? And let’s just kind of review that first. Go ahead.
Dr. Warady: Sure, sure. Well the CKiD study which has been in existence now for more than 15 years; is a study that is comprised of investigators from 54 different pediatric programs around the country. And the goal of the CKiD study was to really gather important data about children with chronic kidney disease, meaning kidney injury but not yet requiring dialysis or transplantation. And what we’ve done over the past 15 years in this study is to learn not only about the risk factors that can lead to worsening of kidney disease in these children; but we’ve also gathered a lot of information about the impact of chronic kidney disease on the growth of these kids, on their brain development and on their risks of heart disease. All important outcomes associated with chronic kidney disease.
Host: Yeah, and so we are kind of – now that’s 15 years that’s been ongoing. I know now, I think you are moving kind of into a new direction with the study. Tell us a little bit about some of the new funding and where the study is heading.
Dr. Warady: Sure. So, the National Institutes of Health which has funded this study, graciously have funded us for an additional five years, which will be twenty years of continuous funding for this study which is really unique in studies funded by the NIH. So, the new aspects of CKiD actually, there’s several new aspects. For one, when we look at the vast majority of children that have entered the study in the past, they were around ten years of age. And so, we really didn’t capture information on our youngest children with chronic kidney disease. Those children who are less than five years of age and believe it or not, there are children that young who already have chronic kidney disease. So, in the new phase of CKiD, we are going to be intensively studying these very young children to see if we can sort of define factors which might allow us to prevent or delay the worsening of kidney disease in these youngest children.
On the other side of the spectrum, historically in CKiD, when children went on to have dialysis or a transplant; they no longer were followed in our study. But in the new phase of CKiD; we are continuing to follow children who are on dialysis and who have been transplanted because a lot of things change in their overall wellbeing during those very important times of their chronic illness and we need to study these so that we can again, hopefully optimize the management of these children of who have gone on to have what we call end-stage kidney disease.
Host: This is a really fascinating study. One of the things that my listeners can do. You can go to the chronic kidney disease in children website. It has all about the CKiD study there and on there, there’s specific study objectives and maybe we can just kind of review what we know about some of these objectives and get your opinion about the future really, for this study. One of the objectives on there is to identify novel and traditional renal disease risk factors to help us understand the progression of chronic kidney disease better. Can you tell us what we have found there through the study?
Dr. Warady: Well to date, we have found a number of risk factors or exposures that lend itself to worsening of the kidney disease. One of the more important ones is high blood pressure. I think many people don’t recognize that even young children can have high blood pressure. And so, high blood pressure in an of itself, can not only lead to the more rapid worsening of kidney function in children; but it can also lead to heart disease. So, that’s an important risk factor. And many children who have kidney disease lose protein in their urine. Typically, the kidney does not lose protein, but in children with kidney disease, you can have protein in the urine and the persistence of protein in the urine can also lead to worsening of kidney disease. And then there’s other factors. Anemia or a low red blood cell count, again, another factor that can lead to progression of chronic kidney disease. So, what we try to find in CKiD are those factors that we call modifiable factors; factors where we can intervene with treatments to hopefully modify the course of chronic kidney disease. And in the CKiD study, we continue to look for these modifiable factors which again, if successfully treated, might improve the outcome for children with chronic kidney disease.
Host: Another objective that you mentioned earlier was understanding or characterizing the impact of a decline in kidney function on neurodevelopment. What have we learned from the CKiD study about that?
Dr. Warady: Well, we’ve learned that children who have chronic kidney disease can have problems with their attention span and with what’s called executive function; being able to make decisions about what to do next in an orderly manner. And so, this is important because if we have children who have these issues going on from a neurocognitive standpoint; oftentimes, that information should be shared with the schools so that the schools can sort of optimize the education of these children so they can be successful and I think in many situations, historically, children who have had these – I don’t want to call them learning disabilities, but challenges if you will, in terms of learning; it’s not been addressed in an aggressive manner in the schools. But I think we know now that many of these children with chronic kidney disease can have these problems and so those kids can work with their own centers to better define these issues that might exist in the children to again, optimize education. And so, this means seeing the psychologist at these centers to pick up on what sometimes can be very subtle abnormalities but can have a huge impact on their learning capacity.
Host: Another objective in the CKiD study was to look at declining kidney function and the affects on overall growth and development. What have we learned from that?
Dr. Warady: Well we have learned certainly, that many of these kids can have short stature and so there’s a multiplicity of factors that influence the growth of children with chronic kidney disease. So, these children have to have a good nutritional status. These children have to have a very normal acid-base status. And both of those factors, nutrition and acid-base control can in fact be abnormal in children with chronic kidney disease. And then we also recognized that in some situations, the use of growth hormone therapy in these children can be extremely, extremely beneficial.
Children with chronic kidney disease don’t have abnormal levels of growth hormone; but the growth hormone levels they have aren’t adequate enough to allow normal growth. And so, some children who have optimized their nutrition, who have optimized their acid-base control should be prescribed growth hormone therapy and in general, will experience a very positive outcome. So, all of these kind of again, pieces of information that we have gathered from CKiD, what we are doing now is putting together this information to share it with their pediatric kidney doctors as well as their pediatricians and their family providers and the families themselves so they understand the complexity of the disorders but that the various interventions that we think are necessary to optimize the care for these kids.
Host: Yeah. With the added funding and the extension of the study for another five years; you’d mentioned one of the populations you are going to look at are the kids who received transplantation are now kind of taken out of the CKiD study in a sense, we are now going to be looking at them. What specifically are you wanting to follow and study in that group?
Dr. Warady: I think one of the most important things in that group study is the issue of cardiovascular or heart disease. When you look at children and adults with chronic kidney disease, or who have gone on to have end-stage kidney disease; cardiac disease is the number one cause of morbidity and mortality, risk of death. And so, we recognize especially in the group that are on dialysis; that’s a period of time when the risk of heart disease is at it’s greatest. And interestingly, if one looks at the studies that are out there; those patients that are between about 18 and 25 or 30 years of age; have been a rather understudied population. So, many of the pediatric studies have stopped when the children are about 18 years of age and then the adult studies that have been done, generally the patients that are enrolled in those studies are more than 30 years of age. So, the CKiD study now and the additional funding, it gives us that opportunity to study this very understudied population. We call them the emerging adults, generally between 19 and 25 years. And so, it’s going to give us sort of an opportunity to fill this information gap that has existed in this population of patients.
Host: Lastly, Dr. Warady, what would you like my listeners to know about the CKiD study and chronic kidney disease in children?
Dr. Warady: Well I think the listeners need to recognize as we said that children can have chronic kidney disease. Children can have high blood pressure. And they need to recognize that when they know of children through acquaintances and the like; who have issues with recurrent kidney infections or they’ve been told they have high blood pressure or their growth doesn’t seem to be quite right; they should recognize that the kidney may be the source of the problem and so, they should visit with their primary care providers and make sure that the providers have assessed the kidney issues. The CKiD study again, is making a lot of new information available to practitioners not only across the country, but around the globe. And so, I’m very optimistic that we will continue to gather more information and we will most definitely continue to improve the care that these kids are being provided.
Host: Dr. Warady, I want to thank you for the work that you are doing and thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to www.childrensmercy.org, that’s www.childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.