Admission characteristics of pediatric chronic kidney disease
Abstract
Background Chronic kidney disease (CKD) in children is a potentially fatal disease if left untreated. Early detection and treatment are important to slow progression to end-stage renal disease requiring dialysis.
Objective We aimed to find characteristics of CKD patients at admission and evaluate factors associated with end-stage CKD (stage 5).
Methods Our cross-sectional study was based on medical records of CKD patients aged less than 18 years in Cipto Mangunkusumo Hospital, Jakarta, from January 2007 to December 2009. Diagnosis and stages of CKD were based on the Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria. Data on disease etiology, symptoms, nutritional status and laboratory tests were collected. Bivariate and multivariate analyses were performed to examine the association between end-stage CKD and its possible risk factors.
Results Of the 142 cases eligible for analysis, 55% were boys. Subjects’ median age was 73.5 months (interquartile range of 23.5-122.5 months). Edema and recurrent fever were the two most frequent symptoms of CKD if diagnosed at stages 2-4, while breathlessness was the most frequent symptom of CKD if diagnosed at stage 5. The most common etiologies were glomerulonephritis (49.3%) and anomalies of the kidney and urinary tract (32.4%). Of our CKD subjects, 21.8% were in stage 5. Independent predictors of stage 5 CKD at presentation were hypertension (OR 3.88; 95% CI 1.17 to 12.87; P=0.026), urea level > 60 mg/dL (OR 39.11; 95%CI 4.86 to 314.74; P<0.001) and non-glomerulonephritis as the etiology (OR 6.51; 95%CI 2.12 to 19.92; P<0.001).
Conclusion Glomerular disease was the most common cause of CKD in our study. Stage 5 CKD was present in 21.8% of subjects at admission and could be predicted by the presence of hypertension, high serum urea level, and non-glomerular disease as the etiology.
References
2. Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol. 2007;22:1999-2009.
3. Ardissino G, Dacco V, Testa S, Bonaudo R, Appiani AC, Taioli M, et.al. Epidemiology of chronic renal failure in children: data from the ItalKid Project. Pediatrics. 2003;111:e382-7.
4. Bek K, Akman S, Bilge H, Topaluglu R, Caliskan S, Peru H, et al. Chronic kidney disease in children in Turkey. Pediatr Nephrol. 2009;24:797-806.
5. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39(suppl 1):S1-S266.
6. Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, et al. National kidney foundation’s kidney disease outcomes quality in Sudanese children: aetiology and outcomes. Pediatr Nephrol. 2009;24:349-53.
11. Fogo AB. Mechanism of progression of chronic kidney disease. Pediatr Nephrol. 2007;22:2011-22.
12. Bhimma R, Adhikari M, Asharam K, Conolly C. The spectrum of chronic kidney disease (stage 2-5) in KwaZulu-Natal, South Africa. Pediatr Nephrol. 2008;23:1841-6.
13. Gonzalez-Celedon C, Bitsori M, Tullus K. Progression of chronic renal failure in children with dysplastic kidneys. Pediatr Nephrol. 2007;22:1014–20.
14. Soares CMB, Diniz JSS, Lima EM, Oliveira GR, Canhesro MR , Colosimo EA, et al. Predictive factors of progression to chronic kidney disease stage 5 in a predialysis interdisciplinary programme. Nephrol Dial Transplant. 2009;24:848-55.
15. Furth SL, Hwang W, Yang C, Neu AM, Fivush BA, Powe NR. Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr Nephrol. 2002;17:450–5.
16. Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D. Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol. 2006;21:793–9.
17. Soares CMB, Diniz JSS, Lima EM, Silva JMP, Oliviera GR, Canhestro MRMR, et al. Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program. Pediatr Nephrol. 2008;23:2039–46.
18. Wong H, Mylera K, Feber J, Drukker A, Filler G. Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int. 2006;70:585–90.
19. Fadrowski JJ, Furth SL, Fivush BA. Anemia in pediatric dialysis patients in end-stage renal disease network 5. Pediatr Nephrol. 2004;19:1029–34.
20. Staples AO, Wong CS, Smith JM, Gipson DS, Filler G, Warady BA, et al. Anemia and risk of hospitalization in pediatric chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:48-56.
21. Mitsnefes MM, Ho PL, McEnery PT. Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol. 2003;14:2618-22.
22. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, et al. Blood pressure in children with chronic kidney disease: a report from the chronic kidney disease in children study hypertension. 2008;52:631-7.
23. Chesney RW, Brewer E, Moxey-Mims M, Watkins S, Furth SL, Harmon WE, et al. Report of an NIH task force on research priorities in chronic kidney disease in children. Pediatr Nephrol. 2006;21:14-25.
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Accepted 2016-10-12
Published 2011-08-30
