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The nation's largest chronic kidney disease study is transforming pediatric care

Children’s Mercy Kansas City is helping lead the transformation of care for children with chronic kidney disease (CKD) as one of two clinical coordinating centers for the Chronic Kidney Disease in Children (CKiD) study. Thanks to renewed funding from the National Institutes of Health, that role will continue through 2018.

Warady-article
Brad Warady, M
Broadening Research through National Partnerships

CKiD is the largest study of CKD in children ever conducted in North America and includes more than 54 participating centers. The additional five years of funding for CKiD not only makes it possible to continue to investigate risk factors that may contribute to the progression of chronic kidney disease, but it also permits further study of the impact of progressive disease on children’s growth, cognitive development and cardiovascular disease status.

Bradley A. Warady, MD, Senior Associate Chair for Children’s Mercy’s Department of Pediatrics and Director, Division of Nephrology, serves as a Co- Principal Investigator for CKiD.

"I don’t know that any of us envisioned the success that we have experienced when we started the study 10 years ago," said Dr. Warady. "Thankfully, due to the hard work of many investigators and coordinators, CKiD has been rewarded with additional funding and time, two important factors when evaluating the progression of a chronic illness."

Significant Findings in CKiD Study Lead to Significant Changes in Treatment

CKiD already has led to a number of significant findings and changes in the way children with CKD are treated.

"One of the things that has become very evident in this study is the relatively high prevalence of cardiovascular disease (CVD), even in children with mild to moderate kidney disease,” Dr. Warady said.

"CKiD also has shown us that the detection of elevated blood pressure through the use of ambulatory blood pressure monitoring can help detect those at risk for CVD so that early and aggressive therapy can be initiated and hopefully lead to improved CVD outcomes for our patients."

Expanding Emphasis on Pediatric Heart Disease

To better understand the risk for heart disease among children with CKD and to complement the regular performance of echocardiograms in CKiD, many patients with moderate to severe kidney disease will undergo cardiac MRI studies in the next phase of CKiD. This will help to better evaluate the impact of progressive CKD on cardiac function.

Additionally, CKiD has led to the development of more accurate means to measure and estimate glomerular filtration rate (GFR) in children, which enhances monitoring of the patients and helps guide therapy.

"The ongoing detection of CKD risk factors such as proteinuria, combined with the accurate measurement of GFR, should not only allow us to predict the timing for renal replacement therapy, but it should ideally stimulate the introduction of therapeutic interventions that could delay or even prevent the progressive disease that many patients currently experience," said Dr. Warady.

Extending Partnerships Across the Globe

Indeed, the information and hypotheses generated by CKiD are expected to ultimately lead to the design of a variety of interventional studies targeted to further advance the care for children with CKD.

The future of CKiD looks bright.

"Before CKiD was initiated 10 years ago, the quantity of research data that was being generated from children with CKD was extremely limited," said Dr. Warady. "Ten years later, we have enrolled nearly 900 children in CKiD, and when you include information from patients in a European cohort with whom we are collaborating on clinical and genetic studies, we’re generating data on nearly 2,000 children with CKD. This substantially increases the likelihood of finding important answers to long-standing questions.”

Without question, CKiD has become a seminal study in the field of pediatric nephrology. 

"CKiD is not just a Kansas City project," said Dr. Warady, "it truly is a global project that is influencing the way all of us care for children with kidney disorders. As for the next five years, the best is yet to come."

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