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Risk factors for progression of chronic kidney disease: An investigation in prepubertal children

Gertruida van Biljon1, Cornelius J Meintjes2, Piet J Becker3

  • 1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa.

Nephrology (Carlton, Vic.)
|March 2, 2023
PubMed

Insights

In pre-pubertal children, common modifiable risk factors do not predict chronic kidney disease (CKD) progression. Non-modifiable factors and proteinuria are key predictors of kidney failure in this age group.

Area of Science:

  • Pediatric Nephrology
  • Renal Medicine
  • Chronic Kidney Disease Research

Background:

  • Previous studies on chronic kidney disease (CKD) progression primarily included post-pubertal children.
  • Limited data exists on risk factors for CKD progression specifically in pre-pubertal children.

Purpose of the Study:

  • To evaluate risk factors associated with the progression of CKD in pre-pubertal children.
  • To identify predictors of kidney failure, time to kidney failure, and rate of kidney function decline in this population.

Main Methods:

  • An observational study included 125 pre-pubertal children (aged 2-10 years) with an estimated glomerular filtration rate (eGFR) between 30 and 75 mL/min/1.73 m².
  • Clinical and biochemical risk factors, along with diagnosis, were analyzed for their association with CKD progression outcomes.

Main Results:

  • 34% of children progressed to CKD stage 5 within a median follow-up of 3.1 years.
  • Hypertension, anemia, and acidosis were associated with progression but not independent predictors of kidney failure.
  • Glomerular disease, proteinuria, and stage 4 CKD were independent predictors of kidney failure and time to kidney failure. Glomerular disease led to a faster decline in kidney function.

Conclusions:

  • Modifiable risk factors at initial evaluation were not independent predictors of CKD progression to kidney failure in pre-pubertal children.
  • Non-modifiable factors and proteinuria predicted eventual stage 5 disease.
  • Pubertal changes may precipitate kidney failure during adolescence.
Abstract

Keywords:
chronic kidney diseasekidneypaediatricpubertyrisk factors

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