Login to Access Video or Poster Abstract: MP61-06
Sources of Funding: Data is this study were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, Ph.D.), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, Ph.D). at the Johns Hopkins Bloomberg School of Public Health. The CKiD is funded by the National Institute of Diabetes and Digestive Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, U01-DK-66116). _x000D_ _x000D_ _x000D_

Introduction

Urological anomalies are a well-established cause of chronic kidney disease (CKD) in children. The standard treatment for some patients with abnormal bladder function is clean intermittent catheterization (CIC). The goal of this study was to determine the prevalence of urinary tract infections and hospitalizations among children who catheterize the bladder, as compared to children who do not.

Methods

The prospective, observational Chronic Kidney Disease in Children (CKiD) study cohort is composed of children, ages 1 to 16, with mild to moderate CKD recruited from 47 North American pediatric nephrology centers. CIC status, hospitalizations and infections were determined using a parent completed questionnaire at study entry or any point along the follow-up for a one-year period. We determined baseline characteristics for this subset and used longitudinal mixed logistic regression models to identify predictors of kidney infections, urinary tract infections and hospitalizations.

Results

A total of 416 CKiD children were included with an underlying urological diagnosis, of whom 105 were on CIC and 311 were not. Median age was 11.9 for CIC and 10.0 for non-CIC patients. Baseline median GFRs were worse in catheter users compared to non-catheter users (53.8 vs 45.6 ml/min/1.73m^2, respectively). Among CIC users, 63% were male, while 71% of non-catheter users were male. Children who catheterized via urethra had on average 3.40-fold odds of hospitalization (95% CI 2.07-5.59, p<0.0001), 4.35-fold odds of bladder infection (95% CI 2.55-7.44, p<0.0001) and 2.56-fold odds of kidney infection (95% CI 1.57-4.17, p=0.0002) compared to children who did not catheterize. Children who performed catheter use via stoma had 6.48-fold odds of hospitalization (95% CI 3.79-11.11, p<0.0001), 7.69-fold odds of bladder infection (95% CI 4.21-14.05, p<0.0001) and 4.19-fold odds of kidney infection (95% CI 2.55-6.87, p<0.0001) compared to children who did not catheterize. A higher percentage of catheter users were seen by a mental health professional at 33% compared to non-catheter users at 14%.

Conclusions

Children with CKD who perform CIC of the bladder via urethra or stoma comprise a clinically distinct subset with increased risk of negative health outcomes and reported more frequent visits to a mental health provider. Recognizing the needs of this vulnerable population can allow for improved care coordination and ultimately improved long term renal function._x000D_ _x000D_ _x000D_

Funding

Data is this study were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, Ph.D.), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, Ph.D). at the Johns Hopkins Bloomberg School of Public Health. The CKiD is funded by the National Institute of Diabetes and Digestive Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, U01-DK-66116). _x000D_ _x000D_ _x000D_