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Clinical profile of children incidentally found to have advanced kidney failure

Wael M Abukwaik1, Rossana Baracco1, Amrish Jain1

  • 1Children's Hospital of Michigan, Central Michigan University, Detroit, USA.

Pediatric Nephrology (Berlin, Germany)
|October 9, 2021
PubMed

Insights

Fifteen percent of children starting kidney replacement therapy (KRT) had advanced kidney failure (KF) incidentally diagnosed. Non-specific symptoms like vomiting and fatigue often mask early signs of chronic kidney disease (CKD) in pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Chronic Kidney Disease Epidemiology
  • Kidney Replacement Therapy

Background:

  • Limited data exist on the epidemiology of children incidentally diagnosed with advanced kidney failure (KF).
  • Unrecognized symptoms and signs of chronic kidney disease (CKD) likely contribute to delayed diagnosis in pediatric populations.
  • This study addresses the knowledge gap regarding incidentally diagnosed advanced KF in children requiring long-term kidney replacement therapy (KRT).

Purpose of the Study:

  • To evaluate the characteristics of incidentally diagnosed pediatric patients with advanced kidney failure.
  • To understand the clinical presentation and comorbidities of children initiating KRT without prior diagnosis of kidney disease.

Main Methods:

  • Retrospective chart review of children initiating KRT (dialysis) was conducted.
  • Inclusion criteria: Children with CKD stage 4 or 5 at presentation and started on chronic KRT within 2 months.
  • Exclusion criteria: Children with a prior diagnosis of underlying kidney disease.

Main Results:

  • 15% (26 of 177) of patients initiating KRT were incidentally diagnosed with advanced KF.
  • The cohort (mean age 12.25 years) comprised 42% males, 54% African Americans, with glomerular (46%) and non-glomerular (54%) etiologies.
  • Common initial symptoms included vomiting (42%) and fatigue (39%); frequent comorbidities were anemia (100%), hypertension (96%), hyperparathyroidism (96%), and hyperphosphatemia (92%).

Conclusions:

  • Under-diagnosis of advanced KF in children is likely due to non-specific symptoms and preserved growth.
  • Prompt initiation of KRT is crucial, with 62% started within 24 hours and 88% within 2 weeks.
  • Increased awareness of subtle CKD signs in children is necessary for earlier detection and intervention.
Abstract

Keywords:
Advanced kidney failureChildrenKidney replacement therapy

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