Evidence map›Paper›PMID 40590957›Full record

Observational studyPediatric nephrology (Berlin, Germany)2025

Practice variation in the use of steroid-sparing therapies in childhood steroid-sensitive nephrotic syndrome: results from a prospective cohort study.

Angie Aguilar-González, Ava Zardynezhad, Catherine Morgan, Allison Dart, Cherry Mammen, Rulan S Parekh, Pavel Geier, Genevieve Benoit, Guido Filler, Janusz Feber and 7 more

Abstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Angie Aguilar-GonzálezDepartment of Pediatrics, SickKids, University of Toronto, Toronto, ON, Canada.
Ava ZardynezhadFaculty of Medicine and Dentistry, University of Alberta, Calgary, AB, Canada.
Catherine MorganDivision of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Allison DartDepartment of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Cherry MammenDivision of Nephrology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Rulan S ParekhDepartment of Pediatrics, SickKids, University of Toronto, Toronto, ON, Canada.
Pavel GeierDivision of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Genevieve BenoitDivision of Nephrology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Québec, Canada.
Guido FillerDivision of Nephrology and Hypertension, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada.
Janusz FeberDivision of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
James TeeDivision of Nephrology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
Steven AroraDivision of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Damien NooneDivision of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Silviu GrisaruDivision of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Rahul ChanchlaniDivision of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Augustina OkpereDivision of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Susan SamuelDivision of Nephrology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. susan.samuel@ubc.ca.ORCID 0000-0003-2224-448X

Funding

Canadian Institutes of Health Research; Kidney Foundation of Canada and Nephcure 1038511Canadian Institutes of Health Research; Kidney Foundation of Canada and Nephcure KFOC-140020Canadian Institutes of Health Research; Kidney Foundation of Canada and Nephcure MOP-142271Canadian Institutes of Health Research; Kidney Foundation of Canada and Nephcure PNI-134070
6 · The paper itself

Abstract

backgroundSteroid-sparing therapies are often used to prolong disease remission while minimizing steroid toxicity in childhood steroid-sensitive nephrotic syndrome (SSNS). This study aims to describe practice variation in the use of steroid-sparing medications for childhood SSNS in Canada.

methodsChildren (1-18 years) with nephrotic syndrome (NS) from eleven pediatric nephrology centers in Canada were enrolled in the Canadian Childhood Nephrotic Syndrome (CHILDNEPH) prospective cohort from 2013-2019. Data, including time to first relapse for children treated with cyclophosphamide, tacrolimus, mycophenolate mofetil, cyclosporine and rituximab were analyzed using summary statistics. Participants who received steroid-sparing therapies prior to enrolment were excluded.

resultsOf the 371 children enrolled, 321 (86.5%) had SSNS and 133 met the study criteria. Median age at enrollment was 3.0 years (IQR: 2.0-6.3). Median follow-up period was 3.0 years (IQR 1.0-4.0). Timing of initiation and choice of steroid-sparing therapy varied across centers. The majority (72.2%) initiated therapies after a median of 3 relapses (IQR: 2-4). Cyclophosphamide and tacrolimus were the most frequently used initial therapies at 39.1% and 23.3%, respectively. Thirty (22.6%) patients switched to a second medication after a median time of 4 months (IQR 0.25-11); of which, 40% switched from either cyclophosphamide or mycophenolate mofetil to tacrolimus. There were no statistically significant differences in time to first relapse with initial therapies (log rank P-value 0.36).

conclusionsSignificant variation in the use of steroid-sparing therapies exists in the treatment of SSNS. A clinical trial is needed to examine the efficacy of these medications to optimize treatment and decrease practice variation.

Indexed as

Immunosuppressive AgentsNephrotic SyndromePractice Patterns, Physicians'AdolescentCanadaChildChild, PreschoolCyclophosphamideCyclosporineFemaleGlucocorticoidsHumansInfantMaleMycophenolic AcidProspective StudiesCyclophosphamideCyclosporineGlucocorticoidsImmunosuppressive AgentsMycophenolic AcidRituximabTacrolimusChildrenPractice variationProspective cohortSteroid-sensitive nephrotic syndromeSteroid-sparing medications

Identifiers

PMID40590957

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.