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10.1007/s00467-016-3512-4

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C5336532!5336532!27826732
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suck abstract from ncbi


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pmid27826732      Pediatr+Nephrol 2017 ; 32 (4): 643-9
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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; Muņoz A
  • Pediatr Nephrol 2017[Apr]; 32 (4): 643-9 PMID27826732show ga
  • Background and objectives: 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: 851 participants (median age: 11 years, median glomerular filtration rate [GFR]: 52 ml/min|1.73 m2, 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 4.1 years median follow-up. At baseline, 472 children (55%) were prevalent RAAS users, who were more likely to be of older age, 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 to 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 models and MSM models, respectively. Conclusions: These results support findings in adult studies of a substantial benefit of RAAS use in pediatric CKD patients.
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