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Trajectories of Kidney Function in Children with Reduced Kidney Function University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2018-05-18 Trajectories of Kidney Function in Children with Reduced Kidney Function Kahlon, Bhavneet Kaur Kahlon, B. K. (2018). Trajectories of Kidney Function in Children with Reduced Kidney Function (Unpublished master's thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/31950 http://hdl.handle.net/1880/106683 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Trajectories of Kidney Function in Children with Reduced Kidney Function by Bhavneet Kaur Kahlon A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE GRADUATE PROGRAM IN COMMUNITY HEALTH SCIENCES CALGARY, ALBERTA MAY, 2018 © Bhavneet Kaur Kahlon 2018 Abstract Little is known about the progression of chronic kidney disease (CKD) during the emerging adulthood period in patients with pediatric onset CKD cared for in primary care. We performed a retrospective cohort study using administrative data from The Health Improvement Network Database to determine the natural history of CKD, the impact of the emerging adulthood period, and the effects of comorbidities including mental health disorders, substance use, and pregnancy on CKD progression. We identified 15,679 patients who met cohort inclusion criteria. We found that kidney function measured using the estimated glomerular filtration rate (eGFR) increased with increasing age. Emerging adulthood was associated with an attenuation in this increase in eGFR. Finally, the presence of mental health disorders, substance use, and pregnancy modified the relationship between age and eGFR resulting in a small, but statistically significant acceleration in the eGFR increase over age, but were associated with lower baseline eGFR. ii Preface This thesis is original, unpublished, independent work by the author, Kahlon, B.K. The research reported in Chapters 2-4 was covered by Ethics Certificate E-24423, issued by the University of Calgary Conjoint Health Ethics Board for the project “The Health Improvement Network Database” on February 21, 2012 (renewed on February 21, 2018). iii Acknowledgements I’d like to start off by thanking my supervisors, Drs. Susan Samuel and Matthew James. Susan, without your guidance, support, and mentorship, this thesis would not have been possible. Thank you for the countless hours you dedicated to guiding me through this process, and for always believing in me. Matt, thank you for supporting this project and agreeing to co-supervise this journey. I cannot thank you enough for your contributions and for always being available to lend your statistical expertise, which was absolutely necessary in seeing this project through to completion. I am also grateful to the rest of my committee members, Drs. Brent Hagel, Daniele Pacaud, and Paul Ronksley. Thank you for your time, thoughtful suggestions, and lending your expertise when I was in need. I’d also like to thank the staff at the Clinical Research Unit at the University of Calgary who worked with me during the very early stages of this project in order to obtain the data required from the THIN database. I’d also like to acknowledge Jane Liang, from the Libin Analysis Core Support team, whose help with coding was a vital part of this process. Finally, I’d like to thank my husband Paul, for his patience, love, and support while I completed this Master’s degree program, as well as my daughter Maya, who was always loving and (mostly) understanding. iv Dedication To Paul, Maya, and baby to be – you are my inspiration v Table of Contents Abstract ............................................................................................................................... ii Preface ................................................................................................................................ iii Acknowledgements ............................................................................................................ iv Dedication ............................................................................................................................v Table of Contents ............................................................................................................... vi List of Tables ..................................................................................................................... ix List of Figures and Illustrations ...........................................................................................x List of Symbols, Abbreviations and Nomenclature ........................................................... xi CHAPTER ONE: INTRODUCTION ..................................................................................1 1.1 INTRODUCTION .....................................................................................................1 1.1.1 Normal kidney function .....................................................................................1 1.1.2 Kidney disease ...................................................................................................2 1.1.3 Pediatric CKD ...................................................................................................3 1.1.4 Emerging adulthood ..........................................................................................5 1.1.5 Childhood chronic disease and transition issues ...............................................7 1.1.6 Transition in the context of kidney disease .......................................................8 1.2 SIGNIFICANCE OF PROJECT ..............................................................................10 1.3 OBJECTIVES & HYPOTHESES ...........................................................................11 1.3.1 Objective 1 .......................................................................................................11 1.3.2 Objective 2 .......................................................................................................12 1.3.3 Objective 3 .......................................................................................................12 CHAPTER TWO: METHODS ..........................................................................................13 2.1 SUMMARY OF METHODS ..................................................................................13 2.2 DATA SOURCE ......................................................................................................13 2.3 POPULATION OF INTEREST ..............................................................................15 2.3.1 Definition of CKD ...........................................................................................16 2.3.2 Inclusion and exclusion criteria .......................................................................16 2.3.3 Patient follow-up .............................................................................................17 2.4 OUTCOME ..............................................................................................................17 2.4.1 Quantifying kidney function: eGFR ................................................................17 2.4.2 Measuring kidney function through childhood to adulthood ..........................18 2.4.3 Height measurement and imputation ...............................................................23 2.5 COVARIATES ........................................................................................................23 2.5.1 Timing of Covariates .......................................................................................25 2.5.2 Other descriptors of the cohort ........................................................................25 2.6 ANALYSIS PLAN ..................................................................................................25 2.6.1. Data cleaning ...........................................................................................26 2.6.2. Descriptive statistics ...............................................................................29 2.6.3. Modeling method ....................................................................................30 2.6.4. Planned analyses .....................................................................................31 2.6.4.1 Preliminary analyses .............................................................................31 vi 2.6.4.2 Objective 1 .............................................................................................33 2.6.4.3 Objective 2 .............................................................................................35 2.6.4.4 Objective 3 .............................................................................................36 2.7 ETHICS AND DATA PRIVACY ...........................................................................37 CHAPTER THREE: RESULTS ........................................................................................38 3.1 PARTICIPANTS .....................................................................................................38 3.2 COHORT CHARACTERISTICS
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