MP51-01 COMPARATIVE ANALYSIS OF CREATININE NADIR CUTOFFS FOR PREDICTING CHILDHOOD RENAL OUTCOMES IN POSTERIOR URETHRAL VALVES

Abstract

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-01 COMPARATIVE ANALYSIS OF CREATININE NADIR CUTOFFS FOR PREDICTING CHILDHOOD RENAL OUTCOMES IN POSTERIOR URETHRAL VALVES Charlotte Wu, Emily Blum, Dattatraya Patil, Stella Shin, and Edwin Smith Charlotte WuCharlotte Wu More articles by this author , Emily BlumEmily Blum More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Stella ShinStella Shin More articles by this author , and Edwin SmithEdwin Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral valves (PUV) are a leading cause of chronic renal failure in childhood. A consistently validated prognostic indicator of renal outcomes is the creatinine nadir. Higher nadirs above historical cutoff values of 0.8 or 1.0 mg/dL correlate with worse renal outcomes. The ability to distinguish early creatinine values more elaborately for patient counseling remains otherwise limited. METHODS: Children with PUV treated by primary valve ablation before 12 months old and followed >2 years were identified. Patient factors including creatinine at presentation (Cr-P), nadir at 6-weeks after ablation (Cr-6W), and nadir at 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) stage. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC), then multivariable logistic regression models compared Cr-P, Cr-6W, and Cr-1Y while adjusting for patient factors. RESULTS: A total of 102 boys were ablated at a mean age of 36.3 (range 0-334) days and followed for 6.6 (±3.7) years. Overall progression to ESRD was 17%. Univariate analysis demonstrated a significant association between lower gestational age and higher Cr-P, Cr-6W, Cr-1Y with incrementally higher CKD stages. On multivariable analysis, when compared to other demographics, only creatinine remained independently, significantly predictive of CKD outcomes. ROC analysis of creatinine for predicting CKD demonstrated excellent diagnostic accuracy for Cr-6W and Cr-1Y (p<0.001) and acceptable accuracy for Cr-P (p<0.005). Using the Cr-6W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome (Table 1). CONCLUSIONS: Cr-6W and Cr-1Y are both excellent predictors of childhood CKD outcomes and are superior to Cr-P. A Cr-6W cutoff of 1.0 mg/dL and Cr-1Y cutoff of 0.8 mg/dL are highly specific and sensitive for ESRD. Children with nadir below historic cutoffs of 0.8 or 1.0 mg/dL do not universally experience a benign renal course. The threshold for concern for CKD3 or higher, for which medical treatment is typically initiated, should start at a Cr-6W nadir > 0.5 mg/dL or Cr-1Y nadir >0.3 mg/dL. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e896-e896 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charlotte Wu More articles by this author Emily Blum More articles by this author Dattatraya Patil More articles by this author Stella Shin More articles by this author Edwin Smith More articles by this author Expand All Advertisement Loading ...