Changing trends in the referral patterns of pediatric nephrology patients

Abstract

This study investigates the changing referral patterns of young patients to a tertiary pediatric nephrology center with a well-defined catchment area over two consecutive 8.5-year periods. We paid special attention to the known increase of obesity and diabetes mellitus in childhood. Demographic data (site of residence, height, weight, gender and renal diagnosis) were collected on 6,154 children aged 0-19 years, referred as in- and outpatients to the Children's Hospital of Eastern Ontario for nephrological work-up. Body mass index (BMI) Z-scores were calculated on the basis of data from the National (USA) Center for Health Statistics (2000). In 6,124 (99.5%) patients a final renal diagnosis could be made, allowing calculation of the incidence of a variety of renal diseases in pediatric patients, data that are not readily available. BMI increased significantly over the years, with a Z-score that rose from a median of +0.20 to +0.32 in the two 8.5-year study periods (p<0.0001). The increase in obesity coincided with a significant increase in the incidence of chronic renal insufficiency (CRI). The combined incidence of CRI and end stage renal disease rose from 0.994 to 2.334 per 100,000 children per year (p=0.0014). This study provides new information on the (changing) pattern of pediatric renal disease over almost two decades. Pediatric renal patients became progressively overweight and showed an increase in the incidence of CRI. This is the first time that this phenomenon, well known in adults, has been observed in the pediatric age group.

Risk factors for glucocorticoid-induced obesity in children with steroid-sensitive nephrotic syndrome

“…The NCHS BMI for age centile curves were created using the LMS method [13], and allow determination of a child's BMI percentile (interchangeable with standard deviation score, or z-score) [13] for age and sex. BMI percentiles, or z-scores, are the accepted way of expressing BMI relative to sex and age in children; this method has been used in many recent studies [14][15][16]. Obesity was defined as BMI >95th percentile for age and sex [17].…”

Report of an NIH task force on research priorities in chronic kidney disease in children

“…A potential primary area of prevention research is to identify biological and environmental risk factors for CKD in children and adolescents [21]. The National Children's study has developed proposals to study risk factors for cardiovascular disease (CVD) and renal disease [22].…”

Selected Primary Care Issues and Comorbidities in Children Who Are on Maintenance Dialysis

“…Emerging data in children support these concerns, with longterm follow-up data from Filler et al (18) confirming that the increase in childhood obesity in their region coincided with a significant increase in the prevalence of CKD and ESRD. Obesity in the pediatric patient with ESRD might also have an impact on selection of dialysis modality, achievement of adequacy, and potential negative impact on kidney allograft func-tion and is an increasing problem in children who present for renal transplantation (19,20).…”