{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T03:37:19Z","timestamp":1767843439139,"version":"3.49.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","award":["Doctoral Research Fellowship 2016-09-055"],"award-info":[{"award-number":["Doctoral Research Fellowship 2016-09-055"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Understanding whether symptoms suggestive of chronic kidney disease (CKD) are reported to primary care before diagnosis may provide opportunities for earlier detection, thus supporting strategies to prevent progression and improve long-term outcomes. Our aim was to determine whether symptoms\/signs or consultation frequency recorded in primary care could predict a subsequent diagnosis of chronic kidney disease in children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We undertook a case-control study within Clinical Practice Research Datalink. Cases were children &lt;21 years with an incident code for severe CKD during the study period (January 2000-September 2018). Controls were matched on age (+\/-3 years), sex, and practice-level kidney function testing rate. Conditional logistic regression modelling was used to identify symptoms predictive of severe CKD and differences in consultation frequency in 24- and 6-month timeframes before the index date.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Symptoms predictive of severe CKD in the 24 months before the index date included growth concerns (OR 7.4, 95% CI 3.5, 15.4), oedema (OR 5.7, 95% CI 2.9, 11.2) and urinary tract infection (OR 3.3, 95% CI 2.1, 5.4); within 6 months of the index date, effect estimates and specificity strengthened although sensitivity decreased. Overall, positive predictive value of symptoms was low. Cases consulted more frequently than controls in both timeframes. In combination, symptoms and consultation frequency demonstrated modest discrimination for CKD (c-statistic after bootstrapping 0.70, 95% CI 0.66, 0.73).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite increased consultation frequency and several symptoms being associated with severe chronic kidney disease, the positive predictive value of symptoms is low given disease rarity making earlier diagnosis challenging.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314084","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T18:30:36Z","timestamp":1739212236000},"page":"e0314084","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Identifying children who develop severe chronic kidney disease using primary care records"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3873-8567","authenticated-orcid":true,"given":"Lucy","family":"Plumb","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish D.","family":"Sinha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-8668","authenticated-orcid":true,"given":"Timothy","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Theresa","family":"Redaniel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Ridd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Owen-Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5199-3925","authenticated-orcid":true,"given":"Fergus J.","family":"Caskey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Ben-Shlomo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"pone.0314084.ref001","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s00467-014-2812-9","article-title":"Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study","volume":"29","author":"NM Rodig","year":"2014","journal-title":"Pediatric Nephrology"},{"issue":"8","key":"pone.0314084.ref002","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1093\/ndt\/gfs299","article-title":"The consequences of chronic kidney disease on bone metabolism and growth in children","volume":"27","author":"J Bacchetta","year":"2012","journal-title":"Nephrology Dialysis Transplantation"},{"issue":"11","key":"pone.0314084.ref003","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1038\/nrneph.2011.116","article-title":"Cardiovascular complications in children with chronic kidney disease","volume":"7","author":"R Shroff","year":"2011","journal-title":"Nature Reviews Nephrology"},{"issue":"2","key":"pone.0314084.ref004","doi-asserted-by":"crossref","first-page":"e349","DOI":"10.1542\/peds.2009-0085","article-title":"Health-related quality of life of children with mild to moderate chronic kidney disease","volume":"125","author":"AC Gerson","year":"2010","journal-title":"Pediatrics"},{"issue":"26","key":"pone.0314084.ref005","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1056\/NEJMoa031643","article-title":"Long-term survival of children with end-stage renal disease","volume":"350","author":"SP McDonald","year":"2004","journal-title":"New England Journal of Medicine"},{"key":"pone.0314084.ref006","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1007\/s00467-020-04611-6","article-title":"Childhood risk factors for adulthood chronic kidney disease","volume":"36","author":"M Stern-Zimmer","year":"2021","journal-title":"Pediatric Nephrology"},{"issue":"17","key":"pone.0314084.ref007","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1056\/NEJMoa0902066","article-title":"Strict blood-pressure control and progression of renal failure in children","volume":"361","author":"Escape Trial Group","year":"2009","journal-title":"New England Journal of Medicine"},{"issue":"8","key":"pone.0314084.ref008","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1007\/s00467-021-05102-y","article-title":"Reducing the burden of cardiovascular disease in children with chronic kidney disease: prevention vs. damage limitation","volume":"36","author":"R. 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KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"A Levin","year":"2013","journal-title":"Kidney international supplements"},{"issue":"4","key":"pone.0314084.ref023","doi-asserted-by":"crossref","first-page":"e0215100","DOI":"10.1371\/journal.pone.0215100","article-title":"Development of a risk score for earlier diagnosis of chronic kidney disease in children","volume":"14","author":"PCK Nogueira","year":"2019","journal-title":"PloS one"},{"key":"pone.0314084.ref024","unstructured":"Clinical Practice Research Datalink website. 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Pearce","year":"2016","journal-title":"BMJ"},{"issue":"571","key":"pone.0314084.ref032","doi-asserted-by":"crossref","first-page":"121","DOI":"10.3399\/bjgp10X483175","article-title":"Cancer diagnosis in primary care","volume":"60","author":"W. Hamilton","year":"2010","journal-title":"British Journal of General Practice"},{"issue":"8","key":"pone.0314084.ref033","doi-asserted-by":"crossref","first-page":"e029686","DOI":"10.1136\/bmjopen-2019-029686","article-title":"The usefulness of symptoms alone or combined for general practitioners in considering the diagnosis of a brain tumour: A case-control study using the clinical practice research database (CPRD) (2000\u20132014).","volume":"9","author":"M Ozawa","year":"2019","journal-title":"BMJ open"},{"key":"pone.0314084.ref034","article-title":"DIAGT: Stata module to report summary statistics for diagnostic tests compared to true disease status","author":"P. Seed","year":"2010"},{"issue":"11","key":"pone.0314084.ref035","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1136\/archdischild-2021-323686","article-title":"Advanced chronic kidney disease among UK children","volume":"107","author":"L Plumb","year":"2022","journal-title":"Archives of Disease in Childhood"},{"issue":"5","key":"pone.0314084.ref036","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.paed.2008.02.003","article-title":"UK law regarding children: essentials for the paediatrician","volume":"18","author":"H. Payne","year":"2008","journal-title":"Paediatrics and Child Health"},{"issue":"1","key":"pone.0314084.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12916-019-1466-7","article-title":"Calibration: the Achilles heel of predictive analytics","volume":"17","author":"B Van Calster","year":"2019","journal-title":"BMC medicine."},{"issue":"2","key":"pone.0314084.ref038","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1177\/1536867X211025836","article-title":"Bootstrap internal validation command for predictive logistic regression models","volume":"21","author":"B Fernandez-Felix","year":"2021","journal-title":"The Stata Journal"},{"issue":"7","key":"pone.0314084.ref039","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1007\/s004670050750","article-title":"Etiology and outcome of chronic renal failure in Indian children","volume":"13","author":"S Gulati","year":"1999","journal-title":"Pediatric Nephrology. September"},{"issue":"1","key":"pone.0314084.ref040","first-page":"79","article-title":"Chronic renal failure in children of Benin","volume":"15","author":"IO Michael","year":"2004","journal-title":"Nigeria. Saudi Journal of Kidney Diseases and Transplantation"},{"issue":"5","key":"pone.0314084.ref041","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1038\/bjc.2011.600","article-title":"Features of childhood cancer in primary care: a population-based nested case\u2013control study","volume":"106","author":"R Dommett","year":"2012","journal-title":"British journal of cancer"},{"issue":"11","key":"pone.0314084.ref042","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1038\/bjc.2013.191","article-title":"Features of cancer in teenagers and young adults in primary care: a population-based nested case\u2013control study","volume":"108","author":"RM Dommett","year":"2013","journal-title":"British journal of cancer"},{"issue":"3","key":"pone.0314084.ref043","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/pedi.12829","article-title":"Presentation to primary care during the prodrome of type 1 diabetes in childhood: A case\u2010control study using record data linkage","volume":"20","author":"J Townson","year":"2019","journal-title":"Pediatric diabetes"},{"issue":"4","key":"pone.0314084.ref044","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1542\/peds.2009-1980","article-title":"Hollenbeak,CS, Widome MD, Paul IM. A cost-effectiveness analysis of screening urine dipsticks in well-child care","volume":"125","author":"DL Sekhar","year":"2010","journal-title":"Pediatrics"},{"key":"pone.0314084.ref045","article-title":"Chronic kidney disease: assessment and management","author":"National Institute for Health and Care Excellence (NICE)."},{"key":"pone.0314084.ref046","article-title":"Chronic kidney disease. 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