Progression of Chronic Kidney Disease in Children With Vesicoureteral Reflux: The North American Pediatric Renal Trials Collaborative Studies Database

Purpose

We describe a cohort of children with chronic kidney disease due to vesicoureteral reflux. We compared the rate of progression to end stage renal disease in those patients to the rate in children with another cause of chronic kidney disease and identified potential risk factors for progression.

Materials and Methods

We performed a retrospective cohort study using data from the North American Pediatric Renal Trials and Collaborative Studies Registry. Patients with vesicoureteral reflux as a cause of chronic kidney disease were compared to 2 other diagnostic cohorts. The 3 groups were compared with respect to baseline characteristics and progression to end stage renal disease based on diagnostic category. Multivariate analysis was performed to identify risk factors for progression to end stage renal disease using Cox proportional hazards regression model.

Results

Data on 6,981 patients were available for analysis. Patients with vesicoureteral reflux as a cause of chronic kidney disease had a significantly slower rate of progression to end stage renal disease than patients with renal aplasia, hypoplasia or dysplasia and all other causes (log rank p <0.0001). On multivariate analysis of risk factors for progression to end stage renal disease in patients with vesicoureteral reflux as the cause of chronic kidney disease we found that, in addition to older age and more advanced chronic kidney disease stage, a history of urinary tract infection at registration was significantly associated with an increased risk of progression.

Conclusions

Children with vesicoureteral reflux had a slower rate of progression to end stage renal disease than children with another cause of chronic kidney disease even after controlling for multiple possible confounders. In children with vesicoureteral reflux as the cause of chronic kidney disease older age, higher chronic kidney disease stage and history of urinary tract infection are significantly associated with the risk of progression to end stage renal disease.

Key Words: kidney, kidney failure, chronic, risk, vesico-ureteral reflux, epidemiology

Abbreviations and Acronyms: CKD, chronic kidney disease, eGFR, estimated GFR, ESRD, end stage renal disease, GFR, glomerular filtration rate, NAPRTCS, North American Pediatric Renal Trials and Collaborative Studies, SDS, standard deviation score, UTI, urinary tract infection, VUR, vesicoureteral reflux