Factors associated with the absence of pharmacological treatment for common modifiable complications in children with chronic kidney disease

Abstract

Background: Chronic kidney disease (CKD) is associated with many comorbidities requiring complex management. We described treatment patterns for common modifiable CKD complications (high blood pressure, anemia, hyperphosphatemia, and acidosis) according to severity of CKD and examined factors associated with the absence of drug therapy, among participants with a persistent comorbidity, for 1 year in children enrolled in the CKiD study.

Methods: A total of 703 CKiD participants contributed 2849 person-visits over a median 3.5 years of follow-up. Using pairs of annual visits, we examined whether participants with abnormal biomarker levels at the first (index) visit persisted in the abnormal levels 1 year later according to CKD risk stage. Multivariate analyses identified demographic and clinical factors associated with the absence of drug therapy among those with persistent comorbid conditions for 1 year.

Results: The overall proportions of person-visits prescribing therapy at 1-year follow-up for treating anemia, acidosis, hyperphosphatemia, and high blood pressure were 54%, 45%, 29%, and 81%, respectively. The frequency of therapy increased with advanced CKD risk stage for all comorbidities; however, 19-23% of participants with acidosis, 24-27% with anemia, and 30-39% with hyperphosphatemia at high-risk stages (E and F) were not prescribed appropriate therapy despite the persistence of abnormal levels of these biomarkers for at least 1 year. The resolution of comorbidities at advanced CKD stages without treatment was unlikely.

Conclusions: Many children with CKD in the CKiD cohort did not receive pharmacological treatment for common and persistent modifiable comorbidities, even in severe CKD risk stages.

Keywords: CKD stage; Children; Treatment initiation.

Conflict of interest statement

Conflict of interest The authors declare no competing interests.

© 2021. IPNA.

Figures

Fig. 1

Proportions of person-visits with abnormal biomarker level at index visit, stratified by chronic kidney disease risk stage. Shaded polygons are proportional to the total area within each diamond for the indicated percent. HTN, hypertension by physicians; Hgb, hemoglobin. Low Hgb is below 5th percentile adjusted for age, sex, and race. Low bicarbonate is

Fig. 2

Proportions with persistent abnormal biomarker levels and no subsequent pharmacological therapy use at 1-year follow-up among those with abnormal biomarker level at index visit, stratified by chronic kidney disease risk stage (proportion with a denominator ≥ 50 person-visits is bolded). Shaded polygons are proportional to the total area within each diamond for the indicated percent. Hgb, hemoglobin. Low Hgb is below 5th percentile adjusted for age, sex, and race. Low bicarbonate is