Predictors of renal replacement therapy and mortality in children with chronic kidney disease

Abstract

Objectives:To study the epidemiology of chronic kidney disease (CKD) in children, and to look for risk factors to predict renal replacement therapy (RRT) and mortality.Methods:This is a retrospective cohort study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 2006 and 2014, where the files of 1,000 children with CKD were reviewed. We determined the effect of consanguinity and hypertension, and being a Saudi indigene on mortality and RRT. We compared children with congenital versus non-congenital causes of CKD.Results:The mean±standard deviation age at presentation was 4.9±4.3 years. The median duration of follow up was 1.5 (interquartile range [IQR]: 0.4-4.0) years. Only 9.7% of children received RRT, and 8.3% died. The underlying etiology for CKD was congenital in 537 children. The congenital CKD group presented at a younger age group (3.5±4.0 versus 6.6±3.9 years, p<0.0001), had more advanced stages of CKD (p<0.0001), higher rates of consanguinity (75.4% versus 47.1%, p<0.0001), and RRT (p<0.004) than children with non-congenital CKD. Risk factors for RRT among children with CKD include being a Saudi indigene (relative risk [RR]=1.49, 95% confidence interval (CI): 1.01-2.21), and hypertensive (RR=5.29, 95% CI: 3.54-7.91). The risk factor for mortality was hypertension (RR=2.46, 95% CI: 1.66-3.65).Conclusion:Congenital causes of CKD represent the main etiology of CKD in children living in the western province of Saudi Arabia. Significant risk factors for RRT include congenital CKD, Saudi nationality, and hypertension. Hypertension is also a predictor of mortality in children with CKD.

Pediatric patients on renal replacement therapy: clinic, epidemiological, social and economic profile

“…There was a predominance of males, which is in accordance with most studies described in the literature. 4,[9][10][11][12][13][14][15] The median age of the patients was 9.25 years at onset on RRT. This finding is very close to those described in articles on RRT, in Serbia 11 which reported a median age of 9.8 years, in Korea 12 where the median age was 9.7 years, and in Brazil 14 which reported 12.5 years in a more recent study by Konstantyner et al 12 A median age of 13 years was found in India.…”

Voiding dysfunction in children causes, management, and prognosis

“…In a previous observational retrospective study from our center in 2015, 1000 children with CKD were enrolled, the incidence of RRT was 7.7% (hemodialysis 3.6%, peritoneal dialysis 2.6%, and kidney transplantation 1.5%), and bladder dysfunction was the most frequent cause of obstructive uropathy (12.1%). 32 McLeod et al, 33 reported in a multicenter study, 274 children with PUV, who were treated before 90 days and were treated for a median of 6.3 years, 16% progressed to ESKD and required RRT by 10 years of age.…”

Pediatric peritoneal dialysis in Brazil: a discussion about sustainability. A document by the Brazilian Society of Nephrology, the Brazilian Society of Pediatrics, the Brazilian Association of Organ Transplantation, and the Brazilian Association of Dialysis and Transplant Centers

“…The treatment of acute and chronic kidney dysfunctions has been the subject of intense discussion, particularly in matters concerning RRT, which includes PD, intermittent and extended HD, and continuous blood purification methods 2 - 4 . Recent studies shed light on the shortage of dialysis supplies in underdeveloped and developing nations 5 .…”