Abstract: FR-PO647
Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study
Session Information
- Pediatric Nephrology - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
- Rickard, Mandy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Jeyakumar, Nivethika, ICES, London, Ontario, Canada
- Smith, Graham Douglas/D, ICES, London, Ontario, Canada
- Dos Santos, Joana R., The Hospital for Sick Children, Toronto, Ontario, Canada
- Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Lorenzo, Armando, The Hospital for Sick Children, Toronto, Ontario, Canada
Background
Posterior urethral valves (PUV) are a common cause of urinary tract obstruction in male infants. However, the long-term kidney outcomes of PUV are uncertain. We aim to determine the risk of major adverse kidney events (MAKE) among PUV patients.
Methods
Retrospective cohort study of all male infants (0-2yr) diagnosed with PUV from 1991-2021 in Ontario, Canada, identified by provincial administrative health databases. We chose two comparator cohorts of males (0-2yr) without PUV: 1) general pediatric population and 2) pyeloplasty patients. Patients were followed until death, provincial emigration, or March 2022 (89%). The primary outcome was modified MAKE (composite of death, chronic kidney replacement therapy (KRT), or de novo chronic kidney disease (CKD)).
Results
We included 727 PUV patients, 855 pyeloplasty patients, and 1,013,052 general pediatric comparators. Median age at PUV diagnosis was 40 days (IQR 10-196). Median follow-up was 16.6 years (IQR 8.6-24.5). During follow-up, 32.3% of PUV patients developed MAKE vs. 5.8% of pyeloplasty patients and 0.8% of general comparators. The adjusted HR for MAKE throughout follow-up was 36.6 (95%CI 31.6-42.4, p<0.001) in PUV patients vs. general comparators. The cumulative incidence of CKD, chronic KRT, hypertension, and incident acute kidney injury were also higher among PUV patients.
Conclusion
PUV patients are at a substantially increased risk of long-term kidney sequelae vs. those without PUV. This justifies enhanced kidney function and blood pressure surveillance among those with a history of PUV.
Table. Cumulative incidence of outcomes
| Outcome | PUV patients, incidence rate per 1000py (95%CI) | Pyeloplasty patients, incidence rate per 1000py (95%CI) | General pediatric comparators, incidence rate per 1000py (95%CI) |
| Major adverse kidney event (MAKE) | 28.4 (25.0-32.2) | 4.5 (3.4-5.9) | 0.49 (0.48-0.50) |
| Kidney replacement therapy (chronic dialysis or kidney transplant) | 6.1 (4.7-7.8) | 0.5 (0.2-1.1) | 0.01 (0.01-0.01) |
| Chronic kidney disease | 26.2 (22.8-30.1) | 4.0 (3.0-5.7) | 0.24 (0.23-0.25) |
| Hypertension | 14.6 (12.3-17.3) | 4.3 (3.2-5.7) | 1.79 (1.77-1.81) |
| Acute kidney injury | 15.8 (13.4-18.6) | 2.8 (2.0-4.0) | 0.27 (0.26-0.28) |
Figure. Cumulative incidence of MAKE among PUV patients vs general pediatric comparators