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Eysenbach G, Kang YX, Duan SB, Yan P, Song GB, Zhang NY, Yang SK, Li JX, Zhang H. Machine Learning-Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and Validation Study. J Med Internet Res 2023; 25:e41142. [PMID: 36603200 PMCID: PMC9893730 DOI: 10.2196/41142] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication following pediatric cardiac surgery, which is associated with increased morbidity and mortality. The early prediction of CSA-AKI before and immediately after surgery could significantly improve the implementation of preventive and therapeutic strategies during the perioperative periods. However, there is limited clinical information on how to identify pediatric patients at high risk of CSA-AKI. OBJECTIVE The study aims to develop and validate machine learning models to predict the development of CSA-AKI in the pediatric population. METHODS This retrospective cohort study enrolled patients aged 1 month to 18 years who underwent cardiac surgery with cardiopulmonary bypass at 3 medical centers of Central South University in China. CSA-AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Feature selection was applied separately to 2 data sets: the preoperative data set and the combined preoperative and intraoperative data set. Multiple machine learning algorithms were tested, including K-nearest neighbor, naive Bayes, support vector machines, random forest, extreme gradient boosting (XGBoost), and neural networks. The best performing model was identified in cross-validation by using the area under the receiver operating characteristic curve (AUROC). Model interpretations were generated using the Shapley additive explanations (SHAP) method. RESULTS A total of 3278 patients from one of the centers were used for model derivation, while 585 patients from another 2 centers served as the external validation cohort. CSA-AKI occurred in 564 (17.2%) patients in the derivation cohort and 51 (8.7%) patients in the external validation cohort. Among the considered machine learning models, the XGBoost models achieved the best predictive performance in cross-validation. The AUROC of the XGBoost model using only the preoperative variables was 0.890 (95% CI 0.876-0.906) in the derivation cohort and 0.857 (95% CI 0.800-0.903) in the external validation cohort. When the intraoperative variables were included, the AUROC increased to 0.912 (95% CI 0.899-0.924) and 0.889 (95% CI 0.844-0.920) in the 2 cohorts, respectively. The SHAP method revealed that baseline serum creatinine level, perfusion time, body length, operation time, and intraoperative blood loss were the top 5 predictors of CSA-AKI. CONCLUSIONS The interpretable XGBoost models provide practical tools for the early prediction of CSA-AKI, which are valuable for risk stratification and perioperative management of pediatric patients undergoing cardiac surgery.
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Affiliation(s)
| | - Yi-Xin Kang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Yan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guo-Bao Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Kun Yang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jing-Xin Li
- Department of Cardiovascular Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Hui Zhang
- Department of Pediatrics, Xiangya Hospital of Central South University, Changsha, China
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Li Y, Xiong M, Yang M, Wang L, Nie S, Liu D, Pi M, Zhang A, Mao J, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, He W, Hou FF, Xu X. Proton pump inhibitors and the risk of hospital-acquired acute kidney injury in children. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1438. [PMID: 33313183 PMCID: PMC7723554 DOI: 10.21037/atm-20-2284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background To evaluate the association between use of proton pump inhibitor (PPI) and the risk of hospital-acquired acute kidney injury (HA-AKI) in hospitalized children. Methods We conducted a multicenter retrospective cohort study in hospitalized children aged 1 month to 18 years from 25 tertiary hospitals across China from 2013 to 2015. Patient-level data were obtained from the electronic hospitalization databases. AKI was defined and staged using the serum creatinine (SCr) data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results Among 42,232 children analyzed, 11,496 (27.2%) used PPI, 1,760 (4.2%) used histamine 2 receptor antagonist (H2RA), and 3,514 (8.3%) had HA-AKI during hospitalization. Over 85% of PPIs were prescribed for prophylaxis of gastro-duodenal lesions in children. The use of PPI was associated with a significantly increased risk of HA-AKI compared with both non-users [odds ratio (OR), 1.37; 95% confidence interval (CI), 1.23–1.53)] and H2RA users (OR, 1.24; 95% CI, 1.01–1.52). The associations were consistent across children of different age range, gender, subtypes of PPIs and methods of administration. A larger effect was observed in children with chronic kidney disease (OR, 3.37; 95% CI, 2.46–4.62) and those needed intensive care (OR, 1.54; 95% CI, 1.33–1.78). The risk of HA-AKI was increased even within the recommended dosage range of PPI. Conclusions PPIs were widely used and associated with an increased risk of HA-AKI in hospitalized children in China.
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Affiliation(s)
- Yanqin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengqi Xiong
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Minliang Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Long Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Diankun Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingjing Pi
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aihua Zhang
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Mao
- Children Hospital of Zhejiang University, Hangzhou, China
| | - Hai-Peng Liu
- Anhui Institute of Pediatric Research, Anhui Provincial Children's Hospital, Hefei, China
| | - Huimin Xia
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hong Xu
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhangsuo Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shipin Feng
- Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Wei Zhou
- Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | | | - Yonghong Yang
- Pediatric Medical Research Center, Gansu Province Child's Hospital, Lanzhou University Second Hospital, Lanzhou, China
| | - Yuhong Tao
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yunlin Feng
- Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunbo Chen
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mo Wang
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zha
- Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China
| | - Jian-Hua Feng
- The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qingchu Li
- Guilin Medical University Affiliated Hospital, Guilin, China
| | - Shuwang Ge
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yongcheng He
- Center for Nephrology and Urology Shenzhen University, the First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Siyuan Teng
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Bi-Cheng Liu
- Institute of Nephrology, Zhong Da Hospital, Nanjing, China
| | - Ying Tang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Xu X, Nie S, Zhang A, Mao J, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, He W, He P, Hou FF. Acute Kidney Injury among Hospitalized Children in China. Clin J Am Soc Nephrol 2018; 13:1791-1800. [PMID: 30287424 PMCID: PMC6302328 DOI: 10.2215/cjn.00800118] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES High-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children's hospitals in China during 2013-2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures. RESULTS A total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates. CONCLUSIONS Pediatric AKI is common and is substantially underdiagnosed in China.
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Affiliation(s)
- Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aihua Zhang
- Department of Nephrology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital of Zhejiang University, Hangzhou, China
| | - Hai-Peng Liu
- Anhui Institute of Pediatric Research, Anhui Provincial Children’s Hospital, Hefei, China
| | - Huimin Xia
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hong Xu
- Department of Nephrology, Children’s Hospital of Fudan University, Shanghai, China
| | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shipin Feng
- Department of Nephrology, Chengdu Women and Children’s Central Hospital, Chengdu, China
| | - Wei Zhou
- Shanghai Children’s Medical Center, Shanghai Jiaotong University, Shanghai, China
| | - Xuemei Liu
- Department of Nephrology, Jinan Children’s Hospital, Jinan, China
| | - Yonghong Yang
- Pediatric Medical Research Center, Gansu Province Child’s Hospital, Lanzhou University Second Hospital, Lanzhou, China
| | - Yuhong Tao
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yunlin Feng
- Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunbo Chen
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mo Wang
- Department of Nephrology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zha
- Guizhou Provincial People’s Hospital, Guizhou University, Guiyang, China
| | - Jian-Hua Feng
- Department of Pediatrics, The Second Affiliated Hospital and
| | - Qingchu Li
- Department of Nephrology, Guilin Medical University Affiliated Hospital, Guilin, China
| | - Shuwang Ge
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yongcheng He
- Center for Nephrology and Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Siyuan Teng
- Department of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chuanming Hao
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhong Da Hospital, Nanjing, China; and
| | - Ying Tang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pinghong He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Xu X, Nie S, Zhang A, Jianhua M, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, Wang LJ, Qi JL, He W, He P, Liu Y, Hou FF. A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine. J Am Soc Nephrol 2018; 29:2432-2442. [PMID: 30054338 DOI: 10.1681/asn.2018010090] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/25/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Current definitions of AKI do not take into account serum creatinine's high variability in children. METHODS We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μmol/L or 30% of the initial creatinine level. RESULTS Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 μmol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions. CONCLUSIONS pROCK criterion improves detection of "true" AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis.
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Affiliation(s)
- Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China;
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aihua Zhang
- Division of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mao Jianhua
- Division of Nephrology, The Children Hospital of Zhejiang University, Hangzhou, China
| | - Hai-Peng Liu
- Anhui Institute of Pediatric Research, Anhui Provincial Children's Hospital, Hefei, China
| | - Huimin Xia
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hong Xu
- Division of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhangsuo Liu
- Division of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shipin Feng
- Division of Nephrology, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Wei Zhou
- Division of Nephrology, Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai, China
| | - Xuemei Liu
- Division of Nephrology, Jinan Children's Hospital, Jinan, China
| | - Yonghong Yang
- Division of Nephrology, Pediatric Medical Research Center, Gansu Province Child's Hospital, Lanzhou University Second Hospital, Lanzhou, China
| | - Yuhong Tao
- Division of Nephrology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yunlin Feng
- Division of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mo Wang
- Division of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zha
- Division of Nephrology, Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China
| | - Jian-Hua Feng
- Division of Pediatrics, The Second Affiliated Hospital and
| | - Qingchu Li
- Division of Nephrology, Guilin Medical University Affiliated Hospital, Guilin, China
| | - Shuwang Ge
- Division of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yongcheng He
- Center for Nephrology and Urology Shenzhen University, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Siyuan Teng
- Division of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhong Da Hospital, Nanjing, China
| | - Ying Tang
- Division of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and
| | - Li-Jun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jin-Lei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenjuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pinghong He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youhua Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China;
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Calderon-Margalit R, Golan E, Twig G, Leiba A, Tzur D, Afek A, Skorecki K, Vivante A. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. N Engl J Med 2018; 378:428-438. [PMID: 29385364 DOI: 10.1056/nejmoa1700993] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The long-term risk associated with childhood kidney disease that had not progressed to chronic kidney disease in childhood is unclear. We aimed to estimate the risk of future end-stage renal disease (ESRD) among adolescents who had normal renal function and a history of childhood kidney disease. METHODS We conducted a nationwide, population-based, historical cohort study of 1,521,501 Israeli adolescents who were examined before compulsory military service in 1967 through 1997; data were linked to the Israeli ESRD registry. Kidney diseases in childhood included congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease; all participants included in the primary analysis had normal renal function and no hypertension in adolescence. Cox proportional-hazards models were used to estimate the hazard ratio for ESRD associated with a history of childhood kidney disease. RESULTS During 30 years of follow-up, ESRD developed in 2490 persons. A history of any childhood kidney disease was associated with a hazard ratio for ESRD of 4.19 (95% confidence interval [CI], 3.52 to 4.99). The associations between each diagnosis of kidney disease in childhood (congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease) and the risk of ESRD in adulthood were similar in magnitude (multivariable-adjusted hazard ratios of 5.19 [95% CI, 3.41 to 7.90], 4.03 [95% CI, 3.16 to 5.14], and 3.85 [95% CI, 2.77 to 5.36], respectively). A history of kidney disease in childhood was associated with younger age at the onset of ESRD (hazard ratio for ESRD among adults <40 years of age, 10.40 [95% CI, 7.96 to 13.59]). CONCLUSIONS A history of clinically evident kidney disease in childhood, even if renal function was apparently normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences.
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Affiliation(s)
- Ronit Calderon-Margalit
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Eliezer Golan
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Gilad Twig
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Adi Leiba
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Dorit Tzur
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Arnon Afek
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Karl Skorecki
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
| | - Asaf Vivante
- From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts
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