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Puberty is associated with increased deterioration of renal function in patients with CKD: data from the ItalKid

Gianluigi Ardissino1, Sara Testa, Valeria Daccò

  • 1Unit of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Archives of Disease in Childhood
|July 27, 2012
PubMed

Insights

Children with chronic kidney disease (CKD) experience a significant decline in kidney survival (KS) during puberty. This critical period, marked by a growth spurt, shows a steep decrease in KS, highlighting the need for further research into underlying mechanisms.

Area of Science:

  • Pediatric Nephrology
  • Renal Disease Progression
  • Adolescent Health

Background:

  • Chronic kidney disease (CKD) affects children, with progression to end-stage renal disease (ESRD) being a major concern.
  • Understanding the factors influencing CKD progression in pediatric populations is crucial for timely intervention.
  • The impact of puberty on renal function decline in children with CKD requires further investigation.

Purpose of the Study:

  • To analyze the timing of end-stage renal disease development in children diagnosed with chronic kidney disease (CKD).
  • To investigate the relationship between pubertal development and the rate of CKD progression in pediatric patients.
  • To identify specific age ranges during which kidney function decline accelerates in children with CKD.

Main Methods:

  • A population-based cohort study utilizing the nationwide ItalKid Project registry.
  • Inclusion of 935 children with CKD, primarily due to renal hypodysplasia, with or without urologic malformations.
  • Kidney survival (KS) was determined by the time to renal replacement therapy (RRT); puberty was staged by growth spurt analysis.

Main Results:

  • A non-linear decline in KS probability was observed, with a marked acceleration during puberty.
  • The probability of requiring RRT was significantly higher in the second decade of life (51.8%) compared to the first (9.4%).
  • A critical inflection point for KS decline was identified around 11.6 years for males and 10.9 years for females.

Conclusions:

  • Puberty is strongly associated with accelerated renal function deterioration in children with CKD.
  • The precise mechanisms driving this puberty-related CKD progression in children remain unidentified.
  • Sex hormones are hypothesized to play a potential role in the accelerated decline of kidney function during puberty in pediatric CKD patients.
Abstract

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