Cardiac Affection in Pediatric CKD Patients in Relation to Hyperuricemia and its Treatment

BackgroundUntargeted plasma metabolomic profiling combined with machine learning (ML) may lead to discovery of metabolic profiles that inform our understanding of pediatric CKD causes. We sought to identify metabolomic signatures in pediatric CKD based on diagnosis: FSGS, obstructive uropathy (OU), aplasia/dysplasia/hypoplasia (A/D/H), and reflux nephropathy (RN).MethodsUntargeted metabolomic quantification (GC-MS/LC-MS, Metabolon) was performed on plasma from 702 Chronic Kidney Disease in Children study participants (n: FSGS=63, OU=122, A/D/H=109, and RN=86). Lasso regression was used for feature selection, adjusting for clinical covariates. Four methods were then applied to stratify significance: logistic regression, support vector machine, random forest, and extreme gradient boosting. ML training was performed on 80% total cohort subsets and validated on 20% holdout subsets. Important features were selected based on being significant in at least two of the four modeling approaches. We additionally performed pathway enrichment analysis to identify metabolic subpathways associated with CKD cause.ResultsML models were evaluated on holdout subsets with receiver-operator and precision-recall area-under-the-curve, F1 score, and Matthews correlation coefficient. ML models outperformed no-skill prediction. Metabolomic profiles were identified based on cause. FSGS was associated with the sphingomyelin-ceramide axis. FSGS was also associated with individual plasmalogen metabolites and the subpathway. OU was associated with gut microbiome–derived histidine metabolites.ConclusionML models identified metabolomic signatures based on CKD cause. Using ML techniques in conjunction with traditional biostatistics, we demonstrated that sphingomyelin-ceramide and plasmalogen dysmetabolism are associated with FSGS and that gut microbiome–derived histidine metabolites are associated with OU.

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Growth Hormone and Insulin-Like Growth Factor Dysregulation in Pediatric Chronic Kidney Disease

Hormone Research in Paediatrics ◽

10.1159/000516558 ◽

2021 ◽

pp. 1-10

Author(s):

Denver D. Brown ◽

Andrew Dauber

Keyword(s):

Chronic Kidney Disease ◽

Growth Hormone ◽

Growth Factor ◽

Kidney Disease ◽

Common Finding ◽

Insulin Like Growth Factor ◽

Contributing Factors ◽

Poor Growth ◽

Negative Effect ◽

Pediatric Ckd

Poor growth is a common finding in children with chronic kidney disease (CKD) that has been associated with poor long-term outcomes. The etiology of poor growth in this population is multifactorial and includes dysregulation of the growth hormone (GH) and insulin-like growth factor (IGF) axis. In this review, we describe the data on GH resistance or insensitivity and inappropriate levels or reduced bioactivity of IGF proposed as contributing factors of growth impairment in children with CKD. Additionally, we describe the theorized negative effect of metabolic acidosis, another frequent finding in pediatric CKD, on the GH/IGF axis and growth. Last, we present the current and potential therapies for the treatment of short stature in pediatric CKD that target the GH/IGF hormonal axis.

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Nutritional Management of the Pediatric CKD Patient

Current Treatment Options in Pediatrics ◽

10.1007/s40746-020-00190-8 ◽

2020 ◽

Vol 6 (2) ◽

pp. 38-51

Author(s):

Jason Thomas ◽

Jessica Nieves ◽

Hiren P. Patel

Keyword(s):

Nutritional Management ◽

Pediatric Ckd

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Child and Parental Perspectives on Communication and Decision Making in Pediatric CKD: A Focus Group Study

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2018.05.005 ◽

2018 ◽

Vol 72 (4) ◽

pp. 547-559 ◽

Cited By ~ 7

Author(s):

Talia Gutman ◽

Camilla S. Hanson ◽

Sarah Bernays ◽

Jonathan C. Craig ◽

Aditi Sinha ◽

...

Keyword(s):

Decision Making ◽

Focus Group ◽

Focus Group Study ◽

Parental Perspectives ◽

Pediatric Ckd

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Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant

Pediatric Nephrology ◽

10.1007/s00467-018-4165-2 ◽

2019 ◽

Vol 34 (5) ◽

pp. 897-905 ◽

Cited By ~ 1

Author(s):

Yijun Li ◽

Larry A. Greenbaum ◽

Bradley A. Warady ◽

Susan L. Furth ◽

Derek K. Ng

Keyword(s):

Short Stature ◽

Kidney Function ◽

Pediatric Ckd ◽

Reduced Kidney Function

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Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study

Frontiers in Pediatrics ◽

10.3389/fped.2020.600907 ◽

2020 ◽

Vol 8 ◽

Author(s):

Ming-Chun Chen ◽

Jen-Hung Wang ◽

Jui-Shia Chen ◽

Yung-Chieh Chang ◽

Rong-Hwa Jan ◽

...

Keyword(s):

School Children ◽

Rural Areas ◽

Early Stage ◽

Fourth Graders ◽

Demographic Factors ◽

Later Life ◽

The Body ◽

Study Cohort ◽

Socio Demographic Factors ◽

Pediatric Ckd

Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan.Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined.Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students.Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.

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RETICULOCYTE HEMOGOBIN EQUIVALENT LEVELS IN PEDIATRIC CKD PATIENTS

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2014.01.036 ◽

2014 ◽

Vol 63 (5) ◽

pp. B23

Keyword(s):

Pediatric Ckd

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Chapter 11. Diagnosis of pediatric CKD

Clinical and Experimental Nephrology ◽

10.1007/s10157-009-0141-2 ◽

2009 ◽

Vol 13 (3) ◽

pp. 215-217

Keyword(s):

Pediatric Ckd

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Enteral Ca-Intake May Be Low and Affects Serum-PTH-Levels in Pre-school Children With Chronic Kidney Disease

Frontiers in Pediatrics ◽

10.3389/fped.2021.666101 ◽

2021 ◽

Vol 9 ◽

Author(s):

Lilith Schmitz ◽

Pamela Hoermann ◽

Birgit Trutnau ◽

Augustina Jankauskiene ◽

Ariane Zaloszyc ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Body Weight ◽

Kidney Disease ◽

Data Collection ◽

Phosphate Binders ◽

Ca Deficiency ◽

Ckd Stage ◽

Pediatric Ckd ◽

Data Collections ◽

Dietary Data

Treatment of chronic kidney disease (CKD) mineral bone disorder (MBD) is challenging in growing children due to the high amount of calcium needed for normal bone mineralization and the required dietary phosphate restriction, which often includes intake of calcium-rich products such as milk. Therefore, enteral calcium-intake (Ca-I) was calculated.Patients: We looked at pediatric CKD-Patients aged 0–6 years.Design: We used a retrospective analysis of Ca-I from dietary data collections. Ca-I below 60% or above 100% of the D-A-CH and the KDOQI reference values were considered as severe Ca deficiency or Ca overload, respectively.Results: We had 41 children, median age 1.1 (range 0-5.8) years, body weight 7.3 (2.4–19.9) kg, and length 68 (48-105) cm at the time of first dietary data collection. Renal function was classified as CKD stage III in 20, IV in 28, V in 44, and VD in 142 dietary data collections. At the first dietary data collection, 5 children were in the CKD stage III, 10 in IV, 9 in V, and 17 were on dialysis. Only one child progressed to a higher CKD stage. In total, 234 dietary data collections were analyzed, and 65 follow-up collections were available from 33 children after a time interval of 26 (1–372) days. The median caloric intake was 120 (47–217)% of D-A-CH RDI. In 149 (63.6%) of the dietary data collections, enteral Ca-I was below the target (<100% of the D-A-CH and KDOQI RDI). Severe Ca-deficiency was found in 11 (26%) and 4 (12%) of the children at the first and second dietary data collection, respectively. In total, 11 children were on Ca-containing phosphate binders. In dietary data collection 1 and 2, there were seven children. From these, 4/7 and 4/7 patients had an enteral total Ca-I above the 100% D-A-CH-limit or above the KDOQI limit, respectively. Absolute dietary Ca-I and Ca-I normalized to body weight correlated negatively with PTH (r = −0.196, p < 0.005 and r = −0.13, p < 0.05).Conclusion: Enteral Ca-I should repeatedly be monitored in CKD children because many may may otherwise be underexposed to enteral calcium and overexposed when calcium-containing phosphate binders are given. Our findings suggest a major impact of dietary calcium supply on bone health in pediatric CKD.

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