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Chronic kidney disease causes and outcomes in children: Perspective from a LMIC setting

Farhana Amanullah1, Amyn A Malik2,3, Zafar Zaidi1

  • 1The Indus Hospital and Health Network, Karachi, Pakistan.

Plos One
|June 8, 2022
PubMed

Insights

Early diagnosis and treatment of pediatric chronic kidney disease (CKD) significantly improve outcomes. Prompt management, especially in low-resource settings, is crucial for preventing severe complications and saving lives in children with CKD.

Area of Science:

  • Pediatric Nephrology
  • Public Health
  • Epidemiology

Background:

  • Chronic kidney disease (CKD) is a significant global health concern affecting children, with higher prevalence in low and middle-income countries (LMICs).
  • Effective prevention, progression slowing, and complication management are critical for pediatric CKD, particularly in resource-limited health systems.
  • Understanding the causes and outcomes of childhood CKD in specific regions like Pakistan is essential for targeted interventions.

Purpose of the Study:

  • To retrospectively review the underlying causes and stages of CKD at presentation in children and adolescents.
  • To evaluate the clinical outcomes of pediatric CKD patients at the Indus Hospital and Health Network (IHHN) in Karachi, Pakistan.
  • To identify factors influencing CKD outcomes in a Pakistani cohort to inform public health strategies.

Main Methods:

  • Retrospective review of pediatric patients (0-16 years) diagnosed with CKD stage 1 or higher.
  • Data collection included demographics, clinical status, laboratory results at presentation and follow-up, surgical interventions, and kidney function.
  • Analysis of outcomes based on CKD stage, underlying cause, and presence of comorbidities.

Main Results:

  • A cohort of 229 children with CKD was analyzed; the median age at diagnosis was 10 years, with a male predominance (1.8:1).
  • Only 5% of children presented with early-stage CKD (stage 1); advanced stages (3-5) were associated with 4.5 times higher adverse outcomes.
  • Congenital anomalies of the kidney and urinary tract (CAKUT) were the most common cause (49%), while glomerular disease correlated with worse outcomes. Proteinuria, hypertension, anemia, and bone disease were linked to high morbidity and mortality.

Conclusions:

  • The precise epidemiology of childhood CKD in Pakistan remains largely unknown.
  • Early diagnosis and appropriate medical/surgical follow-up are associated with improved CKD outcomes in children.
  • Prompt diagnosis, treatment, and prevention of progression are vital for improving survival rates and informing policy changes through CKD registry data.
Abstract

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