ESPN 51th Annual Meeting

ESPN 2018


 
Sex and Glomerular filtration rate trajectories: Insights from the CKiD cohort study
JULIEN HOGAN 1 GEETA KARADKHELE 2 STEPHANIE BONNERIC 3 RACHEL PATZER 2 LARRY GREENBAUM 1

1- PEDIATRIC NEPHROLOGY DEPARTMENT, EMORY UNIVERSITY SCHOOL OF MEDECINE, ATLANTA, GA, USA
2- DEPARTMENT OF SURGERY, EMORY UNIVERSITY SCHOOL OF MEDECINE, ATLANTA, GA, USA
3- PEDIATRIC NEPHROLOGY DEPARTMENT, ROBERT DEBRE UNIVERSITY HOSPITAL, APHP, PARIS, FRANCE
 
Introduction:

The effect of gender on CKD progression has not been specifically studied in children. Moreover, differences in CKD progression have been hypothesized to partially explain gender disparities in access to transplantation. This study aims to identify distinct trajectories of GFR decline and to investigate the effect of gender on GFR decline.

Material and methods:

The CKiD study is a prospective cohort study that enrolled patients 1–16 yrs with an eGFR of 30–90 mL/minute/1.73 m2. Clinical and laboratory data, including GFR, are collected annually. Latent class mixed model was used to identify GFR trajectories. Multinomial logistic regression was used to study patient characteristics associated with each trajectory.

Results:

888 patients were included; Among nonglomerular patients (613), we observed 4 GFR trajectories: 327 with high baseline GFR/slow decline; 20 with high baseline GFR/rapid decline; 35 with median and stable GFR; 231 with low baseline GFR/slow decline. Known risk factors of progression differed between trajectories. The proportion of girls was higher in the group with stable GFR (57%) than in other groups (32-35%). Patients with stable GFR had significantly lower prevalence of acidosis, anemia and proteinuria. Female gender remained associated with the absence of progression (OR 2.7 [1.3-5.5]) after adjusting for other risk factors. This effect remained after stratification on pubertal status. Among glomerular patients (275), we observed 2GFR trajectories: 48 with high baseline/rapid GFR decline; 227 with median GFR/slow GFR decline. Progression was mostly related to the underlying glomerulopathy, with girls presenting more frequently with rapidly progressive diseases such as lupus or crescentic GN.

Conclusions:

The slower progression in girls is driven by a subgroup with nonglomerular diseases and  stable GFR. The effect of gender seems independent of pubertal status, arguing against a direct effect of sex hormone to explain gender disparity in CKD progression.