Chronic kidney disease (CKD) is a major health problem for patients and the NHS. As kidney function fails, complications may occur causing symptoms which require medical review. When kidney function is very low, renal replacement therapy (RRT) is needed to survive: this is either blood cleaning (dialysis) or a kidney transplant.
Childhood is an important time for growth, development and education, which is disrupted for children with severe CKD. Early loss of kidney function means a lifetime of complicated, expensive treatments. In the UK, a quarter of children needing RRT present 'late' to specialists, when their kidney failure is very advanced. Medical treatments can slow or delay progression of CKD if identified early however. Understanding if children who go on to develop severe CKD: (1) report symptoms suggestive of a kidney problem before diagnosis and (2) use primary care as a medical point of contact will help better identify children at risk of CKD progression.
The aim of this study is to explore primary care use and symptoms reported by children who go on to develop severe CKD. This will help us to describe important factors relating to childhood CKD and may help improve earlier detection of late-presenting children.
Chronic kidney disease (CKD) is a significant burden for patients, families and the NHS. CKD progression in childhood not only impacts upon growth, development and schooling, but means a lifetime of renal replacement therapy once end-stage disease is reached. As disease advances, complications relating to kidney function decline are anticipated and may cause symptoms prompting medical review. Medical treatments can slow/delay CKD progression if identified early.
Objective: To explore primary care use and symptoms reported by children who go on to develop severe CKD. This will help us to describe important factors relating to progression of childhood CKD which may help improve detection.
Methods: A nested case-control study will compare symptomatology and consultation frequency of children up to 21 years with severe CKD (stages 4/5/RRT) with controls matched for age (within one year), gender, CPRD time-period (reaching matched age within two years either side of index date) and practice (case:control ratio 1:20). The degree of association of symptoms and consultation frequency with CKD will be tested using conditional logistic regression. We will examine the diagnostic utilities of single and combination features and using ROC curve analysis look at various cut-points to help decide on useful test criteria under different assumptions.
Incident children with severe chronic kidney disease.
Validation of CPRD READ codes for severe childhood chronic kidney disease.
Predictive value of symptoms and consultation patterns for severe kidney disease in children.
Yoav Ben-Shlomo - Chief Investigator - University of Bristol
Lucy Plumb - Corresponding Applicant - University of Bristol
Fergus Caskey - Collaborator - University of Bristol
Manish Sinha - Collaborator - Guy's & St Thomas' NHS Foundation Trust
Matthew Ridd - Collaborator - University of Bristol
Stephanie MacNeill - Collaborator - Imperial College London
Theresa Redaniel - Collaborator - University of Bristol
HES Admitted Patient Care;HES Outpatient;Practice Level Index of Multiple Deprivation