Pediatric Nephrology Fellow Children's Mercy Hospitals and Clinics Overland Park, Kansas, United States
Background: There is a paucity of research on the relationship between adverse childhood events (ACEs) and chronic kidney disease. The effect of ACEs on the long-term health outcomes of cardiovascular disease, cancer, and chronic lung disease first emerged in a paper published in 1998. The National Institutes of Health sponsored the ACE Study, which Kaiser Permanente carried out in California. The study used a 17-question survey addressing seven exposures: psychological, physical, contact-sexual abuse, substance abuse, mental illness, mother being treated violently, and criminal behavior in the household. The results revealed a strong relationship between childhood exposure to ACEs and health outcomes. When individuals experienced four or more such exposures, the odds ratio ranged from 1.6 to 3.9 for ischemic heart disease, cancer, stroke, chronic bronchitis or emphysema, and diabetes (Vincent et al., 1998). This monumental analysis remains a focal point in research more than twenty years after the initial publication of its results. Since then, numerous studies have investigated how childhood exposures can increase disease risk. Surprisingly, chronic kidney disease (CKD) has received little attention in terms of the influence of ACEs in the pediatric and adult populations. Objective: Specific Aim #1: Characterize the prevalence of ACEs in the CKiD cohort. Specific Aim #2: Characterize disease progression among those who experienced ACEs compared to those who have not. Specific Aim #3: Determine if there is a dose-dependent relationship between the number of ACEs and the risk of CKD progression. Design/Methods: Prospective longitudinal observational cohort study: Stratification by exposure: CKiD participants who reported 1 or more ACEs VS CKiD participants who do not report ACEs. Primary outcome: CKD progression defined as a composite endpoint of 50% eGFR decline and/or the initiation of kidney replacement therapy (dialysis or transplant). Inclusion criteria: all CKiD participants with available baseline eGFR and completed questionnaire data regarding ACE exposure.
