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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Pediatr+Nephrol
2017 ; 32
(4
): 643-649
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Renin-angiotensin II-aldosterone system blockers and time to renal replacement
therapy in children with CKD
#MMPMID27826732
Abraham AG
; Betoko A
; Fadrowski JJ
; Pierce C
; Furth SL
; Warady BA
; Muñoz A
Pediatr Nephrol
2017[Apr]; 32
(4
): 643-649
PMID27826732
show ga
BACKGROUND: Clinical care decisions to treat chronic kidney disease (CKD) in a
growing child must often be made without the benefit of evidence from clinical
trials. We used observational data from the Chronic Kidney Disease in Children
cohort to estimate the effectiveness of renin-angiotensin II-aldosterone system
blockade (RAAS) to delay renal replacement therapy (RRT) in children with CKD.
METHODS: A total of 851 participants (median age: 11 years, median glomerular
filtration rate [GFR]: 52 ml/min/1.73 m(2), median urine protein to creatinine
ratio: 0.35 mg/mg) were included. RAAS use was reported at annual study visits.
Both Cox proportional hazards models with time-varying RAAS exposure and Cox
marginal structural models (MSM) were used to evaluate the effect of RAAS use on
time to RRT. Analyses were adjusted or weighted to control for age, male sex,
glomerular diagnosis, GFR, nephrotic range proteinuria, anemia, elevated blood
pressure, acidosis, elevated phosphate and elevated potassium. RESULTS: There
were 217 RRT events over a 4.1-year median follow-up. At baseline, 472 children
(55 %) were prevalent RAAS users, who were more likely to be older, have a
glomerular etiology, have higher urine protein, be anemic, have elevated serum
phosphate and potassium, take more medications, but less likely to have elevated
blood pressure, compared with non-users. RAAS use was found to reduce the risk of
RRT by 21 % (hazard ratio: 0.79) to 37 % (hazard ratio: 0.63) from standard
regression adjustment and MSM models, respectively. CONCLUSIONS: These results
support inferences from adult studies of a substantial benefit of RAAS use in
pediatric CKD patients.
|Age Factors
[MESH]
|Angiotensin II Type 1 Receptor Blockers/*therapeutic use
[MESH]
|Child
[MESH]
|Cohort Studies
[MESH]
|Female
[MESH]
|Glomerular Filtration Rate
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Proteinuria/etiology/therapy
[MESH]
|Renal Insufficiency, Chronic/*therapy
[MESH]
|Renal Replacement Therapy/*statistics & numerical data
[MESH]