ESPN 51th Annual Meeting

ESPN 2018


 
INDIVIDUALIZATION OF RENAL PROTECTION IN CHILDREN WITH CKD
DMYTRO IVANOV 1 STELLA KUSHNIRENKO 1

1- SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION KIEV, UKRAINE
 
Introduction:

 

Renal protection involves implementation of accompanying therapy aimed to preserve renal function for longer periods of time (in ESRD, it is the residual renal function). Evidence-based knowledge on the preservation/recovery of renal function by eGFR have been created for the RAAS blockers.

Material and methods:

 

The database of RAAS blockers (ACEI and ARB) usage has been analysed retrospectively in 512 children 2 to 18 years of age for the period of 1993-2017. The indications for prescription of RAAS blockers were as follows: albuminuria/proteinuria up to 1 g/day with or without concomitant arterial hypertension in documented or no glomerulonephritis, diabetic nephropathy, and polycystic kidney disease. Since 2005, these conditions have been treated as CKD. The criteria for assessment of the prescribed therapy efficacy were as follows: normalization of arterial blood pressure in hypertension, decrease/stabilization of albuminuria/proteinuria, eGFR rate based on Schwartz formula.

Results:

 Analysis of the treatment effectiveness made it possible to formulate the following approaches: In case of hyperfiltration, when eGFR rate is above 120 mL/min/m2, the ACEIs are indicated once a day at bedtime at ½ of the therapeutic dose. For eGFR of 120-60 mL/min/m2 ACEIs or ARBs are shown, a combination of ACEIs + ARBs is possible, but not at the maximum therapeutic doses. In cases of eGFR of 60-30 mL/min/m2 BRAs monotherapy is indicated. For eGFR rates below 30 (20) mL/min/m2 ACEIs and ARBs therapy should be discontinued, or subtherapeutic doses for cardiac indications (heart failure, conditions after acute coronary syndrome) should be used. When haemodialysis is performed, the ACEIs and ARBs should be used for cardiac indications. When a transplant has been received, the ACEIs and ARBs should be administered based on eGFR by creatinine clearance.

Conclusions:

 

Long-term follow-up of CKD patients allowed developing a differentiated approach to the prescription of the ACEIs/ARBs in paediatric population with CKD.