Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study
Bibliographic record
Abstract
Background: Posterior urethral valves (PUV) are a common cause of urinary tract obstruction in male infants. However, the long-term kidney outcomes of PUV are uncertain. We aim to determine the risk of major adverse kidney events (MAKE) among PUV patients. Methods: Retrospective cohort study of all male infants (0-2yr) diagnosed with PUV from 1991-2021 in Ontario, Canada, identified by provincial administrative health databases. We chose two comparator cohorts of males (0-2yr) without PUV: 1) general pediatric population and 2) pyeloplasty patients. Patients were followed until death, provincial emigration, or March 2022 (89%). The primary outcome was modified MAKE (composite of death, chronic kidney replacement therapy (KRT), or de novo chronic kidney disease (CKD)). Results: We included 727 PUV patients, 855 pyeloplasty patients, and 1,013,052 \\ general pediatric comparators. Median age at PUV diagnosis was 40 days (IQR 10-196). Median follow-up was 16.6 years (IQR 8.6-24.5). During follow-up, 32.3% of PUV patients developed MAKE vs. 5.8% of pyeloplasty patients and 0.8% of general comparators. The adjusted HR for MAKE throughout follow-up was 36.6 (95%CI 31.6-42.4, p<0.001) in PUV patients vs. general comparators. The cumulative incidence of CKD, chronic KRT, hypertension, and incident acute kidney injury were also higher among PUV patients. Conclusions: PUV patients are at a substantially increased risk of long-term kidney sequelae vs. those without PUV. This justifies enhanced kidney function and blood pressure surveillance among those with a history of PUV. Table. - Cumulative incidence of outcomes Outcome PUV patients, incidence rate per 1000py (95%CI) Pyeloplasty patients, incidence rate per 1000py (95%CI) General pediatric comparators, incidence rate per 1000py (95%CI) Major adverse kidney event (MAKE) 28.4 (25.0-32.2) 4.5 (3.4-5.9) 0.49 (0.48-0.50) Kidney replacement therapy (chronic dialysis or kidney transplant) 6.1 (4.7-7.8) 0.5 (0.2-1.1) 0.01 (0.01-0.01) Chronic kidney disease 26.2 (22.8-30.1) 4.0 (3.0-5.7) 0.24 (0.23-0.25) Hypertension 14.6 (12.3-17.3) 4.3 (3.2-5.7) 1.79 (1.77-1.81) Acute kidney injury 15.8 (13.4-18.6) 2.8 (2.0-4.0) 0.27 (0.26-0.28) Figure.: Cumulative incidence of MAKE among PUV patients vs general pediatric comparators
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".