Biomarker may predict CKD progression in children
Higher levels of a circulating biomarker were associated with shorter time to kidney replacement therapy and lowering of eGFR in pediatric patients with chronic kidney disease, according to study results.
“I think it is remarkable that we have confirmed findings from recent adult studies demonstrating that [soluble urokinase plasminogen activator receptor] suPAR is a new potential biomarker for kidney progression in children,” Darcy K. Weidemann, MD, MHS, a pediatric nephrologist at Children’s Mercy Kansas City, told Healio Nephrology. “It is notable that the results are confirmed in a pediatric study, where the etiology of CKD is different from that of adults.”
For the study, researchers enrolled 565 children with mild to moderate CKD (aged between 1 and 16 years; median eGFR at baseline, 53.1 mL/min/1.73m2). They measured suPAR levels at study entry and at 6 months, dividing groups into quartiles. CKD progression was defined as the initiation of kidney replacement therapy (dialysis or transplantation) or more than 50% decline in eGFR. Adjustments were made for known CKD progression risk factors.
The researchers found that, when compared with patients in the lowest suPAR quartile, those in the highest experienced a 54% faster progression of CKD (185 reached kidney replacement therapy; 77 had >50% eGFR decline).
This risk decreased after adding eGFR to the model, with patients in the highest quartile experiencing a 33% faster CKD progression compared with those in the lowest quartile.
After 8 years, it was observed that patients in the highest suPAR quartile had a renal survival of 48% vs. a survival of 66% for those in the lowest quartile, suggesting a more rapid progression of CKD with time for those with greater suPAR levels.
Weidemann emphasized the lack of modifiable risk factors which can delay CKD progression as a point of concern, arguing that what physicians currently offer to patients is “limited” (mostly consisting of, she said, aggressive blood pressure and proteinuria control).
“Although there have been some improvements in recent years, our ability to accurately predict which patients’ renal function will deteriorate to a point where we need to consider therapies such as dialysis or kidney transplant is crude,” she said.
According to Weidemann, suPAR may be especially useful in the earliest stages of kidney disease, “where our current biomarkers, like serum creatinine, are the most inadequate.” This would allow the highest risk patients to be identified “before it’s too late.” Therefore, she suggested the utility of this biomarker also be tested in children with mildly impaired kidney function, as well as in those with normal kidney function who are at high risk for the development of kidney disease, so diagnosis and treatment can occur as early as possible.
“We desperately need additional biomarkers to predict which patients are at most risk for progression so we can potentially intervene on these patients sooner, as well as adequately prepare our patients and their families for the prognosis of a potentially grave, life-long chronic illness,” she added. “Our ultimate goal would be to find molecular targets upon which we can design targeted drug therapy to halt the progression of CKD.” – by Melissa J. Webb
Disclosures: Weidemann reports no relevant financial disclosures.