Evaluating Kidney Function Decline in Children with Chronic Kidney Disease Using a Multi-Institutional Electronic Health Record Database.

BACKGROUND: The objectives of this study were to use electronic health record data from a US national multicenter pediatric network to identify a large cohort of children with CKD, evaluate CKD progression, and examine clinical risk factors for kidney function decline. METHODS: This retrospective cohort study identified children seen between January 1, 2009, to February 28, 2022. Data were from six pediatric health systems in PEDSnet. We identified children aged 18 months to 18 years who met criteria for CKD: two eGFR values <90 and ≥15 ml/min per 1.73 m2 separated by ≥90 days without an intervening value ≥90. CKD progression was defined as a composite outcome: eGFR <15 ml/min per 1.73 m2, ≥50% eGFR decline, long-term dialysis, or kidney transplant. Subcohorts were defined based on CKD etiology: glomerular, nonglomerular, or malignancy. We assessed the association of hypertension (≥2 visits with hypertension diagnosis code) and proteinuria (≥1 urinalysis with ≥1+ protein) within 2 years of cohort entrance on the composite outcome. RESULTS: Among 7,148,875 children, we identified 11,240 (15.7 per 10,000) with CKD (median age 11 years, 50% female). The median follow-up was 5.1 (interquartile range 2.8-8.3) years, the median initial eGFR was 75.3 (interquartile range 61-83) ml/min per 1.73 m2, 37% had proteinuria, and 35% had hypertension. The following were associated with CKD progression: lower eGFR category (adjusted hazard ratio [aHR] 1.44 [95% confidence interval (95% CI), 1.23 to 1.69], aHR 2.38 [95% CI, 2.02 to 2.79], aHR 5.75 [95% CI, 5.05 to 6.55] for eGFR 45-59 ml/min per 1.73 m2, 30-44 ml/min per 1.73 m2, 15-29 ml/min per 1.73 m2 at cohort entrance, respectively, when compared with eGFR 60-89 ml/min per 1.73 m2), glomerular disease (aHR 2.01 [95% CI, 1.78 to 2.28]), malignancy (aHR 1.79 [95% CI, 1.52 to 2.11]), proteinuria (aHR 2.23 [95% CI, 1.89 to 2.62]), hypertension (aHR 1.49 [95% CI, 1.22 to 1.82]), proteinuria and hypertension together (aHR 3.98 [95% CI, 3.40 to 4.68]), count of complex chronic comorbidities (aHR 1.07 [95% CI, 1.05 to 1.10] per additional comorbid body system), male sex (aHR 1.16 [95% CI, 1.05 to 1.28]), and younger age at cohort entrance (aHR 0.95 [95% CI, 0.94 to 0.96] per year older). CONCLUSIONS: In large-scale real-world data for children with CKD, disease etiology, albuminuria, hypertension, age, male sex, lower eGFR, and greater medical complexity at start of follow-up were associated with more rapid decline in kidney function.

The representation of plural inflectional affixes in English: Evidence from priming in an auditory lexical decision task.

The representation of inflection is controversial: theories of morphological processing range from those that treat all inflectional morphemes as independently represented in memory to those that deny independent representation for any inflectional morphemes. Whereas identity priming for stems and derivational affixes is regularly reported, priming of inflectional affixes is understudied and has produced no clear consensus. This paper reports results from a continuous auditory lexical decision task investigating priming of plural inflectional affixes in English, in plural prime-target pairs such as crimes→trees. Our results show statistically significant priming facilitation for plural primes relative to phonological (cleanse→trees) and singular (crime→trees) controls. This finding indicates that inflectional affixes, like lexical stems, exhibit identity priming effects. We discuss implications for morphological theory and point to questions for further work addressing which representation(s) produce the priming effect.

Opacity, Transparency, and Morphological Priming: A Study of Prefixed Verbs in Dutch.

A basic question for the study of the mental lexicon is whether there are morphological representations and processes that are independent of phonology and semantics. According to a prominent tradition, morphological relatedness requires semantic transparency: semantically transparent words are related in meaning to their stems, while semantically opaque words are not. This study examines the question of morphological relatedness using intra-modal auditory priming by Dutch prefixed verbs. The key conditions involve semantically transparent prefixed primes (e.g., aanbieden 'offer', with the stem bieden, also 'offer') and opaque primes (e.g., verbieden 'forbid'). Results show robust facilitation for both transparent and opaque pairs; phonological (Experiment 1) and semantic (Experiment 2) controls rule out the possibility that these other types of relatedness are responsible for the observed priming effects. The finding of facilitation with opaque primes suggests that morphological processing is independent of semantic and phonological representations. Accordingly, the results are incompatible with theories that make semantic overlap a necessary condition for relatedness, and favor theories in which words may be related in ways that do not require shared meaning. The general discussion considers several specific proposals along these lines, and compares and contrasts questions about morphological relatedness of the type found here with the different but related question of whether there is morphological decomposition of complex forms or not.