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Nephrology Redefining Care for Kids with CKD

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Nephrology Redefining Care for Kids with CKD
CKiD: Long-term pediatric nephrology study yields results
Presented by Bradley A. Warady, MD, Division Director, Nephrology

As the Midwest Clinical Coordinating Center for the NIH-funded Chronic Kidney Disease in Children (CKiD) study, Children’s Mercy Kansas City is at the center of improving treatment for kids with chronic kidney disease (CKD). Children’s Mercy’s Division Director of Nephrology, Bradley A. Warady, MD, serves as the study’s co-principal investigator. With more than 600 children enrolled in the study from 50 participating sites, CKiD is the largest study of its kind ever conducted in North America.

The goal of this landmark study is to identify the factors that lead to the progression of kidney disease in children and to define the impact of CKD on the growth, neurocognitive development, health-related quality of life (HRQoL) and risk for cardiovascular disease in these patients.

In his role as one of the PIs of the CKiD study, Dr. Warady works closely with the study’s investigators, a collaboration of nephrologists, psychologists and statisticians, to acquire new knowledge about CKD in children and to better understand the impact of current treatment regimes. “Children with chronic kidney disease must deal with a variety of clinical issues that often increase in severity as the disease progresses,” says Dr. Warady. “We are, in turn, tackling some important questions and generating long sought-after answers. The answers will undoubtedly improve how children with CKD are cared for in North America and around the world.”

One recent CKiD analysis revealed that nearly 40 percent of children enrolled in the study had masked hypertension, defined as elevated blood pressure only identified through the use of ambulatory blood pressure monitoring (ABPM). Its presence was also found to be a significant risk factor for left ventricular hypertrophy. “Cardiac deaths account for nearly 25 percent of deaths in children and young adults with end-stage renal disease,” notes Dr. Warady. “Findings from CKiD suggest that the routine use of ABPM in this patient population may help to prevent cardiovascular disease or to detect it early in its course.”

Dr. Warady and his team at Children’s Mercy, along with the CKiD investigators and research coordinators, are most excited about the opportunity to identify patient outcomes in association with their long-term follow up component of the study. “Having collected of a wide range of data repeatedly in a standardized manner makes CKiD uniquely positioned to determine targets for future inverventional studies,” says Dr. Warady. “These studies could make a substantial difference in the quality of care and quality of life for these children.”

Future meetings between Dr. Warady and the CKiD leadership with pediatric investigators from the European ESCAPE trial and adult colleagues from the Chronic Renal Insufficiency Cohort (CRIC) study are also on the schedule for CKiD. “Working together and sharing insights from these other high-quality cohort studies is sure to result in new ideas and new research efforts by our investigators, with the results to be shared with the pediatric nephrology community at large,” explains Dr. Warady.

Helping other physicians gain a better understanding of the needs of patients with CKD is also reflected in Dr. Warady’s passion for improving the success of the pediatric patient’s transition to adult care. For the past two years, the Nephrology Division at Children’s Mercy has hosted a community-wide forum in Kansas City that provides an opportunity for physicians, nurses, social workers, dieticians and other staff members from Children’s Mercy to reach out to adult nephrology caregivers. This helps promote a better continuity of care for patients during this challenging time in their lives.

“Assisting with transition is a critical part of the service we provide to our patients,” observes Dr. Warady. “You can’t just send a young adult off with a two-page summary and expect that to work to their advantage. That’s why we place an emphasis on educating our patients and collaborating with our adult medicine colleagues both before and after the transfer of care to help make the transition process a successful one.”

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