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Risk factors for childhood chronic kidney disease: a population-based study
Michael Geylis1,2, Tara Coreanu3, Victor Novack4,3
1Department of Pediatrics, Soroka University Medical Center, 151 Rager Boulevard, 84101, Beer-Sheva, Israel. michaelGei@clalit.org.il.
Insights
Childhood chronic kidney disease (CKD) is more common than previously thought in southern Israel. Prenatal factors like congenital anomalies and prematurity significantly increase the risk for developing pediatric CKD.
Area of Science:
- Pediatric Nephrology
- Epidemiology
- Public Health
Background:
- Childhood chronic kidney disease (CKD) prevalence and risk factors require better definition.
- A large population-based database in southern Israel was utilized to investigate these factors.
Purpose of the Study:
- To determine the prevalence of childhood CKD in southern Israel.
- To identify perinatal risk factors associated with the development of childhood CKD.
Main Methods:
- Analysis of pre- and post-natal records for 79,374 children born between 2001-2015.
- Definition of "Ever-CKD" based on at least two estimated glomerular filtration rate (eGFR) values below 60 ml/min/1.73 m².
- Logistic regression analysis to identify significant risk factors.
Main Results:
- A prevalence of 882 per million for childhood CKD was found.
- Significant risk factors included congenital anomalies of kidney and urinary tract (CAKUT), glomerulopathy, maternal oligohydramnios, small for gestational age, and prematurity.
- Congenital anomalies and glomerulopathy showed particularly high odds ratios for developing CKD.
Conclusions:
- Childhood CKD is more prevalent in southern Israel than previously reported.
- Prenatal conditions are significant risk factors for developing CKD in childhood.
- Early identification of risk factors is crucial for managing pediatric CKD.
Background:
The population-based prevalence and risk factors of childhood chronic kidney disease (CKD) are not well-defined. We ascertained childhood CKD epidemiology and perinatal risk factors, based on a large computerized medical record database that covers most of southern Israel's population.
Methods:
Pre- and post-natal records of 79,374 eligible children (with at least one serum creatinine test) born during 2001-2015 were analyzed. "Ever-CKD" was defined as ≥ 2 estimated glomerular filtration rate (eGFR) values < 60 ml/min/1.73 m2 beyond age 2 years, more than 3 months apart. The last CKD status was determined on March 2019.
Results:
Of 82 (0.1%) patients with ever-CKD, 35 (42.7%) had their first abnormal eGFR identified already at age 2 years. In multiple logistic regression analysis, congenital anomalies of kidney and urinary tract (CAKUT)-related diagnoses, glomerulopathy, maternal oligohydramnios, small for gestational age, prematurity (under 34 weeks), post-term delivery, and small for gestational age at birth were significant risk factors for ever-CKD (odds ratio (95% confidence interval): 44.34(26.43-74.39), 64.60(32.42-128.70), 5.54(3.01-10.19), 2.02(1.25-3.28), 4.45(2.13-9.28), 2.96(1.28-6.86 and 2.02(1.25-3.28), respectively). Seventy children with ever-CKD (85.4%) had a depressed eGFR (< 90 ml/min/1.73 m2) on the last assessment (current-CKD), yielding a prevalence of 882/million.
Conclusions:
CKD is more prevalent among children in southern Israel than previously reported, even after excluding those with aborted-CKD. Prenatal conditions increase the risk to develop CKD in childhood. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
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