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Sex and Glomerular Filtration Rate Trajectories in Children.

Authors
  • Bonnéric, Stéphanie1
  • Karadkhele, Geeta2
  • Couchoud, Cécile3
  • Patzer, Rachel E2, 4
  • Greenbaum, Larry A5
  • Hogan, Julien6, 2
  • 1 Department of Pediatric Nephrology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. , (France)
  • 2 Department of Surgery, Emory Transplant Center, Emory School of Medicine, Atlanta, Georgia. , (Georgia)
  • 3 Renal Epidemiology and Information Network (REIN) Registry, French Biomedicine Agency, La Plaine-Saint Denis, France. , (France)
  • 4 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; and. , (Georgia)
  • 5 Department of Pediatric Nephrology, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, Georgia. , (Georgia)
  • 6 Department of Pediatric Nephrology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; [email protected] , (France)
Type
Published Article
Journal
Clinical Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Mar 06, 2020
Volume
15
Issue
3
Pages
320–329
Identifiers
DOI: 10.2215/CJN.08420719
PMID: 32111703
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Differences in CKD progression by sex have been hypothesized to explain disparities in access to kidney transplantation in children. This study aims to identify distinct trajectories of eGFR decline and to investigate the association of sex with eGFR decline. We used data from the CKD in Children study. Latent class mixed models were used to identify eGFR trajectories and patient characteristics were compared between trajectories. Progression was studied to two outcomes: ESKD (dialysis or transplantation) and a combined outcome of ESKD or 50% eGFR decline from baseline, using multivariable parametric failure time models. Among 888 patients, 613 with nonglomerular and 275 with glomerular diseases, we observed four and two distinct GFR trajectories, respectively. Among patients with nonglomerular diseases, there was a higher proportion of males in the group with a low baseline GFR. This group had an increased risk of ESKD or 50% GFR decline, despite a similar absolute decline in GFR. Eight patients with nonglomerular diseases, mostly males with obstructive uropathies, had a more rapid absolute GFR decline. However, the association between male sex and rapid absolute GFR decline was NS after adjustment for age, baseline GFR, and proteinuria. Among patients with glomerular diseases, a subgroup including mostly females with systemic immunologic diseases or crescentic GN had a rapid absolute GFR decline. This study identifies different trajectories of CKD progression in children and found a faster progression of CKD in females in patients with glomerular diseases, but no significant sex difference in patients with nonglomerular diseases. The differences in progression seem likely explained by sex differences in the underlying primary kidney disease and in baseline GFR rather than by a direct effect of sex on progression. Copyright © 2020 by the American Society of Nephrology.

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