Simple tool may expedite transplants in kids with kidney failure

December 18, 2017, University of California, San Francisco
Credit: CC0 Public Domain

An easy-to-use tool to predict the likelihood of a child with kidney disease progressing to kidney failure has a high degree of accuracy and could be used to reduce the burden of dialysis and increase transplantations, according to a study led by researchers at UCSF Benioff Children's Hospital San Francisco.

The tool, known as the kidney failure risk equation (KFRE), is already used for adults with kidney disease, with the goal of optimizing planning for dialysis, the researchers say. The study appears in JAMA Pediatrics on Dec. 18, 2017.

"Dialysis has a number of adverse health effects for ," said first author Erica Winnicki, MD, from the Division of Nephrology in the UCSF Department of Pediatrics. "In addition to a higher mortality rate, dialysis is detrimental to cognitive development, growth and cardiovascular health."

A 2016 study found that children who had dialysis for any amount of time had a 69 percent higher risk of death than children who had had a pre-emptive transplant. The average transplant wait time for a child in the United States with kidney failure is less than one year, with wide geographic variability.

In this retrospective study, researchers from four institutions compared the risk of kidney failure predicted by the tool with the actual outcomes of 603 children enrolled in the Chronic Kidney Disease in Children study. At one year, 27 children progressed to kidney failure, at two years 67 progressed to kidney failure and at five years 144 had reached that stage. They found that the tool had a 90 percent probability of discriminating between those children that reached kidney failure and those that would not one year later, 86 percent probability at two years and 81 percent at five years.

Dialysis Is Most Common First Treatment

In children, kidney failure is usually caused by birth anomalies, hereditary diseases and acquired conditions like lupus that impact the body's ability to filter waste and excess fluid from the blood. A total of 1,462 children began treatment for kidney failure in 2013, according to the United States Renal Data Service. The most common initial treatment for these children was dialysis, in which a machine and filter removes waste and fluid, replacing the filtration function of healthy kidneys.

The children in the study, whose average age was 12, had a glomerular filtration rate (GFR) - a measure of how efficiently the kidneys filter blood - below 60, the benchmark for kidney disease. The tool predicts future risk by assessing four variables: age, gender, GFR and the ratio of albumin to creatinine levels, a test to determine elevated protein in urine, a marker of . A second tool, involving an additional four variables, was found to have a similar level of accuracy.

"Currently less than one quarter of children with kidney failure receive a pre-emptive transplant, despite increasing evidence that it improves survival," Winnicki said. "By improving our ability to determine when a child with kidney disease will progress to kidney failure, the risk equation enables the clinical team to better plan for transplant."

Tool May Fast-Forward Vaccinations, Shift Care to Pediatric Specialists

Immunizations should be completed before transplantation because they are less effective afterwards, when patients need to take immunosuppressants to prevent rejection of the new organ. Live vaccines, such as those to prevent measles, mumps and rubella, also could induce disease after transplant, Winnicki noted. As a result, the tool may enable children to receive vaccinations ahead of schedule if kidney failure appears imminent.

Other advantages of accurately predicting the risk of failure include timely transfer of care to a pediatric nephrologist for children in rural areas that are not served by specialists. And in children who are unlikely to undergo pre-emptive transplant, the tool may help clinicians decide when to plan for a surgical fistula or graft, instead of starting with a catheter. Both methods are less likely to cause infections and to need revisions, but can only be used after a period of healing, thus requiring planning, Winnicki said.

"I think what is most remarkable is how well the tool predicts , regardless of whether the patient is a child or adult and regardless of the cause of ," said senior author Elaine Ku, MD, from the Division of Nephrology in the UCSF departments of Medicine and Pediatrics. "The advantage of the is its use of clinically and readily available data to predict future risk."

Explore further: Survival rates are improving for individuals with kidney failure

Related Stories

Survival rates are improving for individuals with kidney failure

December 14, 2017
Individuals with kidney failure have a much higher risk of dying prematurely than people in the general population, but a new analysis indicates that this excess risk is falling. The findings, which come from a study appearing ...

Kidney failure's effects on the psychosocial health and lifestyle of young adults

October 19, 2017
Kidney failure is associated with lower quality of life in young people and limited employment, independence, and relationships compared with healthy peers, according to an analysis appearing in an upcoming issue of the Clinical ...

1 in 7 Americans has kidney disease: CDC

June 9, 2017
(HealthDay)—Thirty million American adults have chronic kidney disease—but many don't know it.

New findings on tolvaptan as autosomal dominant polycystic kidney disease treatment

November 5, 2017
A phase 3 trial studying the effects of tolvaptan has found that the drug slowed the rate of decline in kidney function in patients with the most common form of polycystic kidney disease, a condition with no cure. The results ...

Nighttime blood pressure may predict risk of kidney failure in children

November 3, 2017
Monitoring blood pressure during the night may help identify children with kidney disease who are at risk of progressing to kidney failure, according to a study that will be presented at ASN Kidney Week 2017 October 31-November ...

Racial disparities exist in children's access to kidney transplantation

December 29, 2016
Researchers have uncovered a higher risk of death in black vs. white children with kidney failure over the last two decades that seems to be mediated by differences in access to kidney transplantation. The findings, which ...

Recommended for you

Lung-on-a-chip simulates pulmonary fibrosis

May 25, 2018
Developing new medicines to treat pulmonary fibrosis, one of the most common and serious forms of lung disease, is not easy.

Reconstructing Zika's spread

May 24, 2018
The urgent threat from Zika virus, which dominated news headlines in the spring and summer of 2016, has passed for now. But research into how Zika and other mosquito-borne infections spread and cause epidemics is still very ...

Tick bite protection: New CDC study adds to the promise of permethrin-treated clothing

May 24, 2018
The case for permethrin-treated clothing to prevent tick bites keeps getting stronger.

Molecular network boosts drug resistance and virulence in hospital-acquired bacterium

May 24, 2018
In response to antibiotics, a gene regulation network found in the bacterium Acinetobacter baumannii acts to boost both virulence and antibiotic resistance. Edward Geisinger of Tufts University School of Medicine and colleagues ...

Past use of disinfectants and PPE for Ebola could inform future outbreaks

May 24, 2018
Data from the 2014 Ebola virus outbreak at two Sierra Leone facilities reveal daily usage rates for disinfectant and personal protective equipment, informing future outbreaks, according to a study published May 24, 2018 in ...

Early lactate measurements appear to improve results for septic patients

May 24, 2018
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a bundle of recommendations defining optimal treatment of patients suffering from sepsis, a life-threatening response to infection ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.