Table_3_Risk Factors for Progression of Chronic Kidney Disease With Glomerular Etiology in Hospitalized Children.DOCX

Aim: To Identify association between risk factors to Chronic kidney disease (CKD) stage 5 in children with glomerular diseases in children in China.
Methods: The Hospital Quality Monitoring System database was used to extract data for the study cohort. The primary outcome included progression to CKD stage 5 or dialysis. Cox regression was used to assess potential risk factors. Patients with lower stages (CKD stage 1 and 2) and higher stages (CKD stage 3 and 4) at baseline were analyzed separately.
Results: Of 819 patients (4,089 hospitalization records), 172 (21.0%) patients reached the primary outcome during a median followed-up of 11.4 months. In the lower stages group, factors associated with the primary outcome included older age [Hazard Ratio (HR), 1.21; 95% confidence interval (CI), 1.10–1.34] and out-of-pocket payment (HR, 4.14; 95% CI, 1.57–10.95). In the higher stages group, factors associated with the primary outcome included CKD stage 4 (HR, 2.31; 95% CI, 1.48–3.62) and hypertension (HR, 1.99; 95% CI, 1.29–3.07). The medical migration rate was 38.2% in this study population.
Conclusion: There are different risk factors for progression to the primary outcome in different stages in CKD with glomerular etiology. Further prospective studies are needed to assess these risk factors. The high medical migration rate reflected the regional disparities in the accessibility of pediatric kidney care between regions.

研究目的：明确中国儿童肾小球疾病患儿进展至慢性肾脏病（Chronic kidney disease, CKD）5期的危险因素关联。
研究方法：本研究依托医院质量监测系统（Hospital Quality Monitoring System）数据库提取研究队列数据，主要结局为进展至CKD 5期或接受透析治疗。采用Cox回归分析评估潜在危险因素，并按基线时CKD分期较低组（CKD 1、2期）与较高组（CKD 3、4期）分别进行分析。
研究结果：本研究共纳入819例患儿（含4089条住院记录），经中位随访11.4个月后，172例（21.0%）患儿达到主要结局。低分期组中，与主要结局相关的危险因素包括年龄较大[风险比（Hazard Ratio, HR）=1.21；95%置信区间（confidence interval, CI）：1.10~1.34]与自费支付医疗费用（HR=4.14；95%CI：1.57~10.95）；高分期组中，相关危险因素包括CKD 4期（HR=2.31；95%CI：1.48~3.62）与高血压（HR=1.99；95%CI：1.29~3.07）。本研究队列的医疗流动率为38.2%。
研究结论：不同基线分期的肾小球源性CKD患儿进展至主要结局的危险因素存在差异，需开展进一步前瞻性研究以评估上述危险因素。本研究中较高的医疗流动率反映出我国不同地区间儿童肾脏医疗服务可及性存在区域差异。