Kidney Disease Research Updates
Winter 2008

Research News

NIDDK Conducts Largest Study of Early CKD in Children

Children with chronic kidney disease (CKD) face health issues that can affect their growth, learning, relationships with family and friends, and, ultimately, their chances to lead normal adult lives.

Researchers estimate that children on dialysis are 30 times more likely to die than children in the general population. While the severe health consequences of kidney failure are all too familiar, little is known about the early stages of CKD in children. To learn what risk factors might be modified to slow the progression of CKD, the National Institutes of Health initiated the Chronic Kidney Disease in Children (CKiD) prospective cohort study.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)—in collaboration with the National Institute of Neurologic Disorders and Stroke; the National Institute of Child Health and Human Development; and the National Heart, Lung, and Blood Institute—has recruited almost 540 children with mild to moderately decreased kidney function for the CKiD study. The study was funded for 5 years and will continue for another 5 years due to productivity to date and information coming out of preliminary analyses.

Surprising Results

Early results have already increased researchers’ knowledge about the health of children with CKD.

“The study has revealed the surprising fact that the incidence of low birthweight in this CKD cohort is almost three times the national average,” said Marva Moxey-Mims, M.D., director of the NIDDK’s Pediatric Nephrology and Renal Centers Programs in the Division of Kidney, Urologic, and Hematologic Diseases. According to Moxey-Mims, CKiD is the largest study of its kind for children with CKD.

Researchers are studying risk factors for further kidney function decline, closely monitoring brain development, examining risk factors for heart disease, and looking at the long-term effects of poor growth.

“The study has already improved on methods to measure and estimate kidney function in children with kidney disease,” said Susan Furth, M.D., principal investigator at the Johns Hopkins School of Medicine in Baltimore. “We hope to identify areas that can be targeted with interventions to improve the health and well-being of children with kidney problems. We have already begun to provide new information on the management of blood pressure and anemia in children with CKD back to the doctors caring for the children in the study.”

Study Goals

The specific goals of the study are to

• identify novel and traditional risk factors for CKD progression
• characterize the impact of kidney function decline on neurodevelopment, cognitive abilities, and behavior
• identify the prevalence and evolution of cardiovascular disease risk factors in children with CKD
• examine the effects of a declining glomerular filtration rate on growth and assess the consequences of growth failure on morbidity in children with CKD

Forty-four hospitals and medical centers are participating in the study, with clinical coordinating centers at Johns Hopkins and Children’s Mercy Hospital in Kansas City, MO, and a data coordinating center at the Johns Hopkins Bloomberg School of Public Health.

“The commitment of the pediatric nephrology community, our patients, and their families to CKiD has been phenomenal—a fact that emphasizes the important nature of this project,” said Bradley A. Warady, M.D., chief of pediatric nephrology at Children’s Mercy Hospital and one of the study’s three principal investigators.

Researchers expect the accurate measurement of kidney function at regular intervals in study participants will result in better equations for estimating kidney function in clinical settings. Researchers hope the knowledge gained from this study will eventually lead to well-designed interventional trials and better patient clinical care.

NIH Publication No. 08–4531
March 2008

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