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Publications

Journal Article Epublish

PubMed: 40485719 DOI: 10.1016/j.ekir.2025.02.007

Longitudinal Lipid Trajectories and Progression of CKD in Children.

Kidney Int Rep 10(5):1393-1403

Authors: Uwe Querfeld, Marietta Kirchner, Francesca Mencarelli, Karolis Azukaitis, Aysun Bayazit, Ali Duzova, Anke Doyon, Nur Canpolat, Ipek Kaplan Bulut, Lukasz Obrycki, Justine Bacchetta, Rukshana Shroff, Dusan Paripovic, Cengiz Candan, Jerome Harambat, Alev Yilmaz, Harika Alpay, Jun Oh, Hakan Erdogan, Claus P Schmitt, Anette Melk, Franz Schaefer

Affiliations

  • Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité University Hospital, Berlin, Germany.
  • Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
  • Pediatric Nephrology Unit, Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • Department of Pediatric Nephrology, Cukurova University, Adana, Turkey.
  • Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
  • Pediatric Nephrology Division, Department of Pediatrics I, University of Heidelberg, Heidelberg, Germany.
  • Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
  • Division of Pediatric Nephrology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey.
  • Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland.
  • Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France.
  • UCL Great Ormond Street Institute of Child Health, London, UK.
  • Nephrology Department, University Children's Hospital and School of Medicine, University of Belgrade, Serbia.
  • Division of Pediatric Nephrology, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey.
  • Pediatric Nephrology Unit, Department of Pediatrics, Bordeaux University Hospital, France.
  • Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Department of Pediatric Nephrology, Marmara University Faculty of Medicine, Istanbul, Turkey.
  • Pediatric Nephrology, UKE University Children's Hospital, Hamburg, Germany.
  • Department of Pediatric Nephrology, Dörtçelik Children's Hospital, Bursa, Turkey.
  • Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.

Abstract

Introduction

There are discrepant findings regarding the effect of dyslipidemia on disease progression in adult patients with chronic kidney disease (CKD).

Methods

In a prospective cohort study of children with stage 3 to 5 (predialysis) CKD, triglycerides (TGs), total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured semiannually. We investigated whether CKD progression is associated with serum lipid levels at baseline and with lipid trajectories during follow-up. CKD progression was defined as the time to a composite event of 50% reduction in estimated glomerular filtration rate (eGFR), eGFR < 10 ml/min per 1.73 m 2, or start of kidney replacement therapy. By semiparametric group-based trajectory modeling (GBTM), 2 trajectories were defined for each lipid, termed "high" and "low."

Results

A total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min per 1.73 m 2 were included. Kidney diagnosis was classified as congenital anomalies of the kidneys and urinary tracts (CAKUT) in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. During a median of 5.1 years of follow-up, 59% of patients reached the composite end point. Kidney survival was significantly different for HDL-C (P = 0.0128), but not for other lipid trajectories in the Kaplan-Meier analysis. There was no significant association of any of the lipid trajectories with CKD progression in Cox proportional hazard models. Variables consistently associated with CKD progression in models for each lipid at baseline and for lipid trajectories included age, a diagnosis other than CAKUT, eGFR at baseline, albuminuria, the serum albumin level, and diastolic blood pressure (BP).

Conclusions

These data do not support an important role for lipids in the progression of CKD in children.

MeSH

Proteinuria, Cholesterol, Ldl, Serum, Lipoproteins, Dyslipidemias, Kidney, Cholesterol, Diagnosis, Cholesterol, Hdl, Child