1
|
Chainoglou A, Evripidou K, Stabouli S. Assessment of obesity in pediatric kidney transplant recipients: an ongoing challenge. Pediatr Nephrol 2025; 40:2113-2116. [PMID: 39912908 DOI: 10.1007/s00467-025-06706-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 01/24/2025] [Accepted: 01/27/2025] [Indexed: 02/07/2025]
Affiliation(s)
- Athanasia Chainoglou
- 1St Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Kleo Evripidou
- 1St Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Stella Stabouli
- 1St Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
| |
Collapse
|
2
|
Plumb L, Sinha MD, Jones T, Redaniel MT, Ridd MJ, Owen-Smith A, Caskey FJ, Ben-Shlomo Y. Identifying children who develop severe chronic kidney disease using primary care records. PLoS One 2025; 20:e0314084. [PMID: 39928602 PMCID: PMC11809798 DOI: 10.1371/journal.pone.0314084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 11/05/2024] [Indexed: 02/12/2025] Open
Abstract
BACKGROUND Understanding whether symptoms suggestive of chronic kidney disease (CKD) are reported to primary care before diagnosis may provide opportunities for earlier detection, thus supporting strategies to prevent progression and improve long-term outcomes. Our aim was to determine whether symptoms/signs or consultation frequency recorded in primary care could predict a subsequent diagnosis of chronic kidney disease in children. METHODS We undertook a case-control study within Clinical Practice Research Datalink. Cases were children <21 years with an incident code for severe CKD during the study period (January 2000-September 2018). Controls were matched on age (+/-3 years), sex, and practice-level kidney function testing rate. Conditional logistic regression modelling was used to identify symptoms predictive of severe CKD and differences in consultation frequency in 24- and 6-month timeframes before the index date. RESULTS Symptoms predictive of severe CKD in the 24 months before the index date included growth concerns (OR 7.4, 95% CI 3.5, 15.4), oedema (OR 5.7, 95% CI 2.9, 11.2) and urinary tract infection (OR 3.3, 95% CI 2.1, 5.4); within 6 months of the index date, effect estimates and specificity strengthened although sensitivity decreased. Overall, positive predictive value of symptoms was low. Cases consulted more frequently than controls in both timeframes. In combination, symptoms and consultation frequency demonstrated modest discrimination for CKD (c-statistic after bootstrapping 0.70, 95% CI 0.66, 0.73). CONCLUSION Despite increased consultation frequency and several symptoms being associated with severe chronic kidney disease, the positive predictive value of symptoms is low given disease rarity making earlier diagnosis challenging.
Collapse
Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, UK Kidney Association, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, United Kingdom
| | - Timothy Jones
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - M. Theresa Redaniel
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Matthew J. Ridd
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Amanda Owen-Smith
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
3
|
Soeiro EMD, Penido MGMG, Sylvestre LDC, Andrade MC, de Alcantara SAG, Machado IC, Bedram LG, Abreu ALS. DOMINÓ Registry: study protocol on mineral and bone disease (DOença MINeral e Óssea) of chronic kidney disease in pediatrics in Brazil. J Bras Nefrol 2025; 47:e20240054. [PMID: 39776148 PMCID: PMC11706022 DOI: 10.1590/2175-8239-jbn-2024-0054en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 09/08/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Pediatric patients with chronic kidney disease (CKD) develop mineral and bone disorders (MBD). We do not have Brazilian data that evaluate these outcomes, which can be obtained through epidemiological records. OBJECTIVE To present the DOMINÓ study, which aims to describe CKD-MBD characteristics in Brazilian pediatric patients. METHODS Retrospective and prospective, multicenter, observational cohort. The retrospective study will analyze data from prevalent patients in 2024, and the prospective study will analyze data from 2025 onwards. Demographic, clinical, laboratory, imaging, and bone biopsy data will be collected from pediatric patients with CKD-MBD < 18 years old with CKD stage 3-5D and kidney transplant recipients. The Ethics Committees of the participating centers approved the study. DISCUSSION/CONCLUSION The DOMINÓ study will provide information on the incidence, prevalence, morbidity, treatment results, and mortality of this pediatric disease in Brazil. Future analyses will allow us to identify predictors of response to treatment and improve the care for these patients.
Collapse
Affiliation(s)
- Emília Maria Dantas Soeiro
- Universidade Federal de Pernambuco, Recife, PE, Brazil
- Faculdade Pernambucana de Saúde, Recife, PE, Brazil
- Instituto de Medicina Integral Professor Fernando Figueira, Recife,
PE, Brazil
| | - Maria Goretti Moreira Guimarães Penido
- Santa Casa de Belo Horizonte, Centro de Nefrologia, Unidade de
Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Unidade
de Nefrologia Pediátrica, Hospital das Clínicas, Belo Horizonte, MG, Brazil
| | - Lucimary de Castro Sylvestre
- Hospital Pequeno Príncipe, Unidade de Nefrologia Pediátrica,
Curitiba, PR, Brazil
- Pontifícia Universidade Católica do Paraná, Curitiba, PR,
Brazil
| | | | | | - Ivan Coelho Machado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto,
Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | | | | |
Collapse
|
4
|
Abderraman GM, Niang A, Mohamed T, Mahan JD, Luyckx VA. Understanding Similarities and Differences in CKD and Dialysis Care in Children and Adults. Semin Nephrol 2023; 43:151440. [PMID: 38016864 DOI: 10.1016/j.semnephrol.2023.151440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
In lower-income settings there is often a dearth of resources and nephrologists, especially pediatric nephrologists, and individual physicians often find themselves caring for patients with chronic kidney diseases and end-stage kidney failure across the age spectrum. The management of such patients in high-income settings is relatively protocolized and permits high-volume services to run efficiently. The basic principles of managing chronic kidney disease and providing dialysis are similar for adults and children, however, given the differences in body size, causes of kidney failure, nutrition, and growth between children and adults with kidney diseases, nephrologists must understand the relevance of these differences, and have an approach to providing quality and safe dialysis to each group. Prevention, early diagnosis, and early intervention with simple therapeutic and lifestyle interventions are achievable goals to manage symptoms, complications, and reduce progression, or avoid kidney failure in children and adults. These strategies currently are easier to implement in higher-resource settings with robust health systems. In many low-resource settings, kidney diseases are only first diagnosed at end stage, and resources to pay out of pocket for appropriate care are lacking. Many barriers therefore exist in these settings, where specialist nephrology personnel may be least accessible. To improve management of patients at all ages, we highlight differences and similarities, and provide practical guidance on the management of children and adults with chronic kidney disease and kidney failure. It is important that children are managed with a view to optimizing growth and well-being and maximizing future options (eg, maintaining vein health and optimizing cardiovascular risk), and that adults are managed with attention paid to quality of life and optimization of physical health.
Collapse
Affiliation(s)
- Guillaume Mahamat Abderraman
- Department of Nephrology-Dialysis, Renaissance University Hospital Center, University of N'Djamena, Chad, Africa.
| | - Abdou Niang
- Department of Nephrology-Dialysis, Dalal Diam University Hospital Center, Cheikh Anta Diop University of Dakar, Senegal, Africa
| | - Tahagod Mohamed
- Pediatric Nephrology, The Ohio State University College of Medicine, Columbus OH
| | - John D Mahan
- Pediatric Nephrology, The Ohio State University College of Medicine, Columbus OH; Nationwide Children's Hospital Center for Faculty Development, Columbus OH
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
5
|
Li H, Xia Z, Li L, Lu Z, Du F, Ye Q, Peng G. Successful rescue of renal transplantation with cardiac arrest after electrical storm: A case report. Medicine (Baltimore) 2022; 101:e32030. [PMID: 36451434 PMCID: PMC9704926 DOI: 10.1097/md.0000000000032030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Most patients with end-stage chronic kidney disease are associated with complications such as renal hypertension, renal anemia, hyperkalemia, water-sodium retention, and disorders of acid-base balance after long-term renal replacement therapy, which can lead to increased cardiac burden, some degree of myocardial damage, and finally progress to arrhythmia and heart failure. These are the main reasons why patients with chronic kidney disease are prone to cardiovascular events after renal transplantation. PATIENT CONCERNS We report a case of sudden onset of ventricular fibrillation on the postoperative second day, with repeated electrical storm accompanied by cardiac arrest during resuscitation, a very long cardiopulmonary resuscitation (CPR) process of 5 hours and 14 minutes, and >20 cycles of cardiac defibrillation. DIAGNOSES According to the patient history and resuscitation process, a diagnosis of ES with cardiac arrest after renal transplantation was formulated. INTERVENTION According to the American Heart Association guidelines for CPR and cardiovascular emergencies, resuscitation measures such as CPR, tracheal intubation, electric defibrillation, symptomatic medication, etc. were performed on the patient. OUTCOMES Finally, the patient was successfully resuscitated, after which the patient had stable respiratory circulation and no neurological complications. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 5 hours and 14 minutes. LESSONS This case of adequate resuscitation can provide experience and a basis for CPR of patients with in-hospital complications of cardiovascular events for a long time.
Collapse
Affiliation(s)
- Hao Li
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang Shandong, China
| | - Zhiping Xia
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
| | - Ling Li
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
| | - Zhongshan Lu
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
| | - Futian Du
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang Shandong, China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
| | - Guizhu Peng
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, China
- *Correspondence: Guizhu Peng, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, 430071, China (e-mail: )
| |
Collapse
|
6
|
Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics 2022; 150:189711. [PMID: 36217888 DOI: 10.1542/peds.2022-057956] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Over the last decades, childhood and adolescence have emerged as an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. Here, we discuss the underlying advances in the field. First, atherosclerosis development starts as early as childhood. Atherogenesis initiates in the iliac arteries and abdominal aorta and subsequently develops in higher regions of the arterial tree, as has been demonstrated in nonhuman primate studies and human autopsy studies. Obesity, hypertension, hyperlipidemia, and hyperglycemia at a young age can accelerate atherogenesis. Children and adolescents with obesity have a relative risk of ∼ 2.5 for ASCVD mortality later in life, compared to peers with a normal weight. Conversely, early prevention improves long-term cardiovascular outcomes. Second, we review disease-associated factors that add to the traditional risk factors. Various pediatric disorders carry similar or even higher risks of ASCVD than obesity, including chronic inflammatory disorders, organ transplant recipients, familial hypercholesterolemia, endocrine disorders, childhood cancer survivors, chronic kidney diseases, congenital heart diseases, and premature birth, especially after fetal growth restriction. The involved disease-associated factors that fuel atherogenesis are diverse and include inflammation, vascular, and endothelial factors. The diverse and growing list of pediatric groups at risk underscores that cardiovascular risk management has solidly entered the realm of general pediatrics. In a second review in this series, we will, therefore, focus on recent advances in cardiovascular risk assessment and management and their implications for pediatric practice.
Collapse
Affiliation(s)
- Henk S Schipper
- Department of Pediatric Cardiology.,Center for Translational Immunology, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts
| |
Collapse
|
7
|
da Silva Selistre L, Renard C, Bacchetta J, Goutagny MP, Hu J, Carla de Souza V, Bertrand Y, Dubourg L, Domenech C. Teenagers and young adults with a past of allogenic hematopoietic stem cell transplantation are at significant risk of chronic kidney disease. Pediatr Nephrol 2022; 37:1365-1375. [PMID: 34735600 DOI: 10.1007/s00467-021-05319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (aHSCT) remains the treatment of choice for some malignant hemopathies in children, albeit with the risk of long-term consequences, including chronic kidney disease (CKD). METHODS In our single tertiary referral center, we retrospectively assessed the long-term renal outcome in a cohort of children and adolescents who had undergone aHSCT for malignant hemopathies between 2003 and 2017. We distinguished glomerular and tubular dysfunctions and assessed the accuracy of the most common formula(s) to estimate glomerular filtration rate (GFR) during standard clinical follow-up. RESULTS Among the 166 patients who had received aHSCT, 61 underwent kidney functional assessment 1 to 10 years post-transplantation. Twenty-seven patients (44.3%) had a CKD with glomerular impairment, including 20 patients with a GFR < 90 mL/min/1.73 m2, and among these, 5 patients < 60 mL/min/1.73 m2. Patients with tubular signs had a significantly higher baseline GFR: 112 mL/min/1.73 m2 [100; 120] versus 102 [99.0; 112.5] for patients without kidney involvement, and 76 [61; 86] for patients with CKD (p < 0.01). Schwartz, CKiDU25, and EKFC formulas significantly overestimated mGFR, with a P30% ≤ 30%, which could lead to overlooking CKD diagnosis in this population. No patient reached kidney failure. CONCLUSIONS In conclusion, our study shows that CKD represents an important long-term sequela for children and adolescents who undergo aHSCT for malignant hemopathies, either with glomerular dysfunction or with the more insidious tubular dysfunction which could potentially impact growth. These patients could benefit from specialized long-term nephrology follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Luciano da Silva Selistre
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Cécile Renard
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Justine Bacchetta
- Centre de Référence Des Maladies Rénales Rares, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie-Pierre Goutagny
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Julie Hu
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Vandréa Carla de Souza
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Carine Domenech
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France.
- Faculté de Médecine Et de Maïeutique Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052, CNRS 5286, Université Lyon 1, Lyon, France.
| |
Collapse
|
8
|
Epstein M, Freundlich M. The intersection of Mineralocorticoid Receptor (MR) activation and the FGF23 - Klotho cascade. A Duopoly that promotes renal and cardiovascular injury. Nephrol Dial Transplant 2021; 37:211-221. [PMID: 34459924 DOI: 10.1093/ndt/gfab254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
The nexus of CKD and cardiovascular disease (CVD) amplifies the morbidity and mortality of CKD, emphasizing the need for defining and establishing therapeutic initiatives to modify and abrogate the progression of CKD and concomitant CV risks. In addition to the traditional CV risk factors, disturbances of mineral metabolism are specific risk factors that contribute to the excessive CV mortality in patients with CKD. These risk factors include dysregulations of circulating factors that modulate phosphate metabolism including fibroblast growth factor 23 (FGF23) and soluble Klotho. Reduced circulating levels and suppressed renal klotho expression may be associated with adverse outcomes in CKD patients. While elevated circulating concentrations or locally produced FGF23 in the strained heart exert pro-hypertrophic mechanisms on the myocardium, Klotho attenuates tissue fibrosis, progression of CKD, cardiomyopathy, endothelial dysfunction, vascular stiffness, and vascular calcification. Mineralocorticoid receptor (MR) activation in non-classical targets, mediated by aldosterone and other ligands, amplifies CVD in CKD. In concert, we detail how the interplay of elevated FGF23, activation of the MR, and concomitant reductions of circulating Klotho in CKD, may potentiate each other's deleterious effects on kidney and the heart, thereby contributing to the initiation and progression of kidney and cardiac functional deterioration, acting through multipronged albeit complementary mechanistic pathways.
Collapse
Affiliation(s)
- Murray Epstein
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Freundlich
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|