Kidney Morbidity in Pediatric Patients With Spina Bifida

Area of Science:

• Nephrology
• Pediatric Urology
• Epidemiology

Background:

• Improved medical care increases lifespan for spina bifida patients.
• Kidney morbidity is a growing concern and significant burden of disease in this population.
• Understanding kidney disease progression in spina bifida is crucial for long-term management.

Purpose of the Study:

• To determine the incidence rate and age of onset for kidney morbidity in pediatric spina bifida patients.
• To identify clinical factors associated with kidney disease development in this cohort.
• To compare kidney disease incidence and onset in spina bifida patients versus the general population.

Main Methods:

• A retrospective cohort study analyzed administrative health records of publicly insured individuals in Ontario, Canada.
• Included were 12,868 pediatric patients with spina bifida and 4,367,881 controls, followed from birth.
• Chronic kidney disease (CKD) and end-stage renal disease (ESRD) incidence rates and age of onset were primary outcomes.

Main Results:

• Spina bifida patients had higher incidence rates for CKD (2.7 vs 0.3 per 1000 person-years) and ESRD (0.3 vs 0.01 per 1000 person-years).
• CKD onset was significantly earlier in spina bifida patients (median 5 years) compared to controls (median 10 years).
• Earlier birth year, male sex, comorbidities, diabetes, UTIs, and urologic surgery were linked to CKD development.

Conclusions:

• Pediatric patients with spina bifida face substantially elevated risks of CKD and ESRD.
• Kidney disease onset occurs approximately 5-7 years earlier in spina bifida patients.
• Identified clinical factors highlight the need for vigilant pediatric surveillance for kidney health.