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Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania
Jūratė Masalskienė1, Šarūnas Rudaitis1, Renata Vitkevič2
1Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Insights
The prevalence of pediatric chronic kidney disease (CKD) in Lithuania increased significantly by 2017, primarily due to congenital anomalies of the kidney and urinary tract (CAKUT). Advanced CKD stages in children were linked to higher rates of hypertension and anemia.
Area of Science:
- Pediatric Nephrology
- Epidemiology
- Public Health
Background:
- Limited data exists on pediatric chronic kidney disease (CKD) prevalence.
- Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of CKD in children.
- CKD progression can lead to serious complications and end-stage renal disease (ESRD).
Purpose of the Study:
- To determine the causes, stage, prevalence, and clinical signs of CKD in Lithuanian children in 2017.
- To assess the demand for renal replacement therapy (RRT) in this population.
- To compare 2017 epidemiological data with previous data from 1997 and 2006.
Main Methods:
- Retrospective analysis of data from 172 Lithuanian children diagnosed with CKD (stages 2-5) in 1997, 2006, and 2017.
- Assessment of physical development and clinical signs in children with CKD (stages 2-5) in 2017.
- Statistical analysis to compare prevalence and identify risk factors.
Main Results:
- CKD prevalence (stages 2-5) increased from 48.0 pmarp in 1997 to 132.1 pmarp in 2017.
- CAKUT remained the primary cause of CKD, accounting for 79% of cases in 2017.
- In 2017, children with CKD stages 4-5 (excluding transplanted) had high rates of hypertension (87.5%) and anemia (50%).
- Children under 2 years with CKD had a 3-fold increased risk of elevated blood pressure.
Conclusions:
- While the number of children with CKD remained stable, prevalence increased due to a declining pediatric population.
- CAKUT is consistently the main cause of pediatric CKD.
- Hypertension and anemia are significant comorbidities in advanced pediatric CKD, with early-onset hypertension observed in younger children.
Abstract:
Background and Objectives: The data on the prevalence of chronic kidney disease (CKD) in the pediatric population are limited. The prevalence of CKD ranges from 56 to 74.7 cases per million of the age-related population (pmarp). The most common cause of CKD among children is congenital anomalies of the kidney and urinary tract (CAKUT). With progressing CKD, various complications occur, and end-stage renal disease (ESRD) can develop. The aim of the study was to determine the causes, stage, prevalence, and clinical signs of CKD and demand for RRT (renal replacement therapy) among Lithuanian children in 2017 and to compare the epidemiological data of CKD with the data of 1997 and 2006. Materials and Methods: The data of 172 Lithuanian children who had a diagnosis of CKD (stage 2-5) in 1997 (n = 41), in 2006 (n = 65), and in 2017 (n = 66) were retrospectively analyzed. Physical development and clinical signs of children who had CKD (stage 2-5) in 2017 were assessed. Results: The prevalence of CKD stages 2-5 was 48.0 pmarp in 1997; 88.7 in 2006; and 132.1 in 2017 (p < 0.01). Congenital and hereditary diseases of the kidney in 1997 accounted for 66% of all CKD causes; in 2006, for 70%; and in 2017, for 79%. In 2017, children with CKD stages 4 or 5 (except transplanted children) had hypertension (87.5%) and anemia (50%) (p < 0.01). Children under ≤2 years with CKD were at a 3-fold greater risk of having elevated blood pressure (OR = 3.375, 95% CI: 1.186-9.904). Conclusions: There was no change in the number of children with CKD in Lithuania; however, the prevalence of CKD increased due to reduced pediatric population. CAKUT remains the main cause of CKD at all time periods. Among children with CKD stages 4 or 5, there were more children with hypertension and anemia. In children who were diagnosed with CKD at an early age hypertension developed at a younger age.
