Higher eGFR at dialysis initiation is not associated with a survival benefit in children

Erica Winnicki, Kirsten L. Johansen, Michael D. Cabana, Bradley A. Warady, Charles E. McCulloch, Barbara Grimes, Elaine Ku

Research output: Contribution to journalArticle

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Abstract

Background Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. Methods To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1–18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2).Results Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality—hemodialysis versus peritoneal dialysis (P<0.001 for interaction)—and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively).Conclusions In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.

Original languageEnglish (US)
Pages (from-to)1505-1513
Number of pages9
JournalJournal of the American Society of Nephrology
Volume30
Issue number8
DOIs
StatePublished - Aug 2019
Externally publishedYes

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Dialysis
Survival
Chronic Kidney Failure
Confidence Intervals
Renal Dialysis
Thinness
Peritoneal Dialysis
Information Systems
Cohort Studies
Retrospective Studies
Pediatrics
Kidney
Therapeutics

ASJC Scopus subject areas

  • Nephrology

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Higher eGFR at dialysis initiation is not associated with a survival benefit in children. / Winnicki, Erica; Johansen, Kirsten L.; Cabana, Michael D.; Warady, Bradley A.; McCulloch, Charles E.; Grimes, Barbara; Ku, Elaine.

In: Journal of the American Society of Nephrology, Vol. 30, No. 8, 08.2019, p. 1505-1513.

Research output: Contribution to journalArticle

Winnicki, Erica ; Johansen, Kirsten L. ; Cabana, Michael D. ; Warady, Bradley A. ; McCulloch, Charles E. ; Grimes, Barbara ; Ku, Elaine. / Higher eGFR at dialysis initiation is not associated with a survival benefit in children. In: Journal of the American Society of Nephrology. 2019 ; Vol. 30, No. 8. pp. 1505-1513.
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title = "Higher eGFR at dialysis initiation is not associated with a survival benefit in children",
abstract = "Background Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. Methods To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1–18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2).Results Of 15,170 children, 4327 (29{\%}) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95{\%} confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality—hemodialysis versus peritoneal dialysis (P<0.001 for interaction)—and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95{\%} confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95{\%} confidence interval, 0.91 to 1.25; respectively).Conclusions In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.",
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T1 - Higher eGFR at dialysis initiation is not associated with a survival benefit in children

AU - Winnicki, Erica

AU - Johansen, Kirsten L.

AU - Cabana, Michael D.

AU - Warady, Bradley A.

AU - McCulloch, Charles E.

AU - Grimes, Barbara

AU - Ku, Elaine

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N2 - Background Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. Methods To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1–18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2).Results Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality—hemodialysis versus peritoneal dialysis (P<0.001 for interaction)—and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively).Conclusions In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.

AB - Background Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. Methods To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1–18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2).Results Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality—hemodialysis versus peritoneal dialysis (P<0.001 for interaction)—and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively).Conclusions In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.

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