Acute kidney injury in children with chronic kidney disease is associated with faster decline in kidney function
PEDIATRIC NEPHROLOGY
Authors: Melhem, Nabil; Rasmussen, Pernille; Joyce, Triona; Clothier, Joanna; Reid, Christopher J. D.; Booth, Caroline; Sinha, Manish D.
Abstract
Background This study aimed to investigate the association of acute kidney injury (AKI) with change in estimated glomerular filtration rate (eGFR) in children with advanced chronic kidney disease (CKD). Methods Single centre, retrospective longitudinal study including all prevalent children aged 1-18 years with nondialysis CKD stages 3-5. Variables associated with CKD were analysed for their potential effect on annualised eGFR change (Delta GFR/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated. Results Of 147 children, 116 had at least 1-year follow-up in a dedicated CKD clinic with mean age 7.3 +/- 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 +/- 11.9 ml/min/1.73 m(2) with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean Delta GFR/year for all patients was - 1.08 +/- 5.64 ml/min/1.73 m(2) but reduced significantly from 2.03 +/- 5.82 to - 3.99 +/- 5.78 ml/min/1.73 m(2) from youngest to oldest age tertiles (P < 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, P = 0.048) but no difference in AKI incidence (37% versus 31%, P = 0.85) between age tertiles. Multiple regression analysis identified age (beta = - 0.53, P < 0.001) and AKI (beta = - 3.2, P = 0.001) as independent predictors of Delta GFR/year. 48.7% versus 22.1% with and without AKI reached composite end-point (P = 0.01). Conclusions We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction.
Circulating tumor DNA in advanced solid tumors: Clinical relevance and future directions
CA-A CANCER JOURNAL FOR CLINICIANS
Authors: Cheng, Michael L.; Pectasides, Eirini; Hanna, Glenn J.; Parsons, Heather A.; Choudhury, Atish D.; Oxnard, Geoffrey R.
Abstract
The application of genomic profiling assays using plasma circulating tumor DNA (ctDNA) is rapidly evolving in the management of patients with advanced solid tumors. Diverse plasma ctDNA technologies in both commercial and academic laboratories are in routine or emerging use. The increasing integration of such testing to inform treatment decision making by oncology clinicians has complexities and challenges but holds significant potential to substantially improve patient outcomes. In this review, the authors discuss the current role of plasma ctDNA assays in oncology care and provide an overview of ongoing research that may inform real-world clinical applications in the near future.
COA
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