What is the true burden of chronic kidney disease in children worldwide?

Harambat, Jérôme; Madden, Iona

doi:10.1007/s00467-022-05816-7

Cited by 20 publications

(11 citation statements)

References 31 publications

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“…The heterogeneity of causes and the lack of complete understanding of mechanisms underlying CKD in children are reflected in the absence of effective treatments to slow CKD disease progression and prolong patient survival, with profound implications for morbidity and mortality. Given the economical and organizational concerns related to CKD, any intervention potentially leading to preventing its progression toward kidney failure is crucial and would be required to appropriately allocate resources [ 7 ]. The main step on this path is the identification and correct disease classification, which is still difficult given the peculiarities of pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms underlying CKD progression are multifactorial and only partially understood [ 1 ]. The still low disease awareness further contributes to a general lack of effort in identifying the causes behind its progression [ 1 , 7 ]. The scenario is particularly complex in children and young adults where CKD results mainly from hereditary disorders, birth defects or aggressive treatments causing AKI (e.g.…”

Section: Mechanisms Of Ckd Progression In Childrenmentioning

confidence: 99%

“…Given the physiological age-related modification of GFR in the first years of life, the definition of CKD is challenging per se in the pediatric population. Moreover, pediatric CKD presents an additional complexity represented by an extremely variable spectrum of clinical presentations, ranging from completely silent disease (common for structural disorders) to severe kidney function impairment that markedly affects the life expectancy and quality of life of patients and their caregivers [ 7 ]. The advent and spreading of massive-parallel sequencing (MPS) technology has recently opened an interesting opportunity to promote a revision of the epidemiology of CKD in children, supporting the hypothesis that CKD is much more frequent than currently reported in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

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Chronic kidney disease in children: an update

Cirillo

Chiara

Innocenti

et al. 2023

Clinical Kidney Journal

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Chronic kidney disease (CKD) is a major healthcare issue worldwide. However, the prevalence of pediatric CKD has never been systematically assessed and consistent information is lacking in this population. The current definition of CKD is based on glomerular filtration rate (GFR) and the extent of albuminuria. Given the physiological age-related modification of GFR in the first years of life, the definition of CKD is challenging per se in the pediatric population, resulting in high risk of underdiagnosis in this population, treatment delays and untailored clinical management. The advent and spreading of massive-parallel sequencing technology has prompted a profound revision of the epidemiology and on the causes of CKD in children, supporting the hypothesis that CKD is much more frequent than currently reported in children and adolescents. This acquired knowledge will eventually converge in the identification of the molecular pathways and cellular response to damage, with new specific therapeutic targets to control disease progression and clinical features of children with CKD. In this review, we will focus on recent innovations in the field of pediatric CKD and in particular those where advances in knowledge have become available in the last years, to the aim of providing a new perspective on CKD in children and adolescents.

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Section: Discussionmentioning

confidence: 99%

Section: Mechanisms Of Ckd Progression In Childrenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic kidney disease in children: an update

Cirillo

Chiara

Innocenti

et al. 2023

Clinical Kidney Journal

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“…National epidemiological studies in Asian, European, and North and South American countries suggest that the prevalence of CKD in children is 30–100 per million age-related population per year [ 1 ]. The most common causes of CKD in children include congenital anomalies of the kidneys and urinary tract (CAKUT) followed by glomerular and systemic immunological diseases [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating the use of finerenone in children with chronic kidney disease and proteinuria: design of the FIONA and open-label extension studies

Schaefer,

Montini,

Kang

et al. 2024

Trials

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Introduction Proteinuria is a modifiable risk factor for chronic kidney disease (CKD) progression in children. Finerenone, a selective, non-steroidal, mineralocorticoid receptor antagonist (MRA) has been approved to treat adults with CKD associated with type 2 diabetes mellitus (T2DM) following results from the phase III clinical trials FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049). In a pre-specified pooled analysis of both studies (N = 13,026), finerenone was shown to have an acceptable safety profile and was efficacious in decreasing the risk of adverse kidney and cardiovascular outcomes and of proteinuria. Objective FIONA and the associated open-label extension (OLE) study aim to demonstrate that combining finerenone with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) is safe, well-tolerated, and effective in sustainably reducing urinary protein excretion in children with CKD and proteinuria. Design FIONA (NCT05196035; Eudra-CT: 2021–002071-19) is a randomized (2:1), double-blind, placebo-controlled, multicenter, phase III study of 6 months’ duration in approximately 219 pediatric patients. Patients must have a clinical diagnosis of CKD (an eGFR ≥ 30 mL/min/1.73 m2 if ≥ 1 to < 18 years or a serum creatinine level ≤ 0.40 mg/dL for infants 6 months to < 1 year) with significant proteinuria despite ACEi or ARB usage. The primary objective is to demonstrate that finerenone, added to an ACEi or ARB, is superior to placebo in reducing urinary protein excretion. FIONA OLE (NCT05457283; Eudra-CT: 2021–002905-89) is a single-arm, open-label study, enrolling participants who have completed FIONA. The primary objective of FIONA OLE is to provide long-term safety data. FIONA has two primary endpoints: urinary protein-to-creatinine ratio (UPCR) reduction of ≥ 30% from baseline to day 180 and percent change in UPCR from baseline to day 180. A sample size of 198 participants (aged 2 to < 18 years) in FIONA will provide at least 80% power to reject the null hypothesis of either of the two primary endpoints. Conclusion FIONA is evaluating the use of finerenone in children with CKD and proteinuria. Should safety, tolerability, and efficacy be demonstrated, finerenone could become a useful additional therapeutic agent in managing proteinuria and improving kidney outcomes in children with CKD. Trial registration ClinicalTrials.gov NCT05196035. Registered on 19 January 2022.

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“…Only a few studies have assessed CKD stages 2–5 in children with the use of estimated glomerular filtration rate (eGFR) according to KDIGO guidelines, and almost none investigates chronicity criterion (3 months of observation) to exclude transient fluctuations in kidney function. Nevertheless, data from the last 3 decades estimate the prevalence of pediatric CKD between 30 and 50 per million age-related population (pmarp) per year [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Protein Biomarkers in Chronic Kidney Disease in Children—What Do We Know So Far?

Szumińska

Wasilewska

Kamianowska

2023

JCM

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Chronic kidney disease (CKD) in children is a major concern of medical care and public health as it is related to high morbidity and mortality due to progression to end-stage kidney disease (ESKD). It is essential to identify patients with a risk of developing CKD to implement therapeutic interventions. Unfortunately, conventional markers of CKD, such as serum creatinine, glomerular filtration rate (GFR) and proteinuria, have many limitations in serving as an early and specific diagnostic tool for this condition. Despite the above, they are still the most frequently utilized as we do not have better. Studies from the last decade identified multiple CKD blood and urine protein biomarkers but mostly assessed the adult population. This article outlines some recent achievements and new perspectives in finding a set of protein biomarkers that might improve our ability to prognose CKD progression in children, monitor the response to treatment, or even become a potential therapeutic target.

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What is the true burden of chronic kidney disease in children worldwide?

Cited by 20 publications

References 31 publications

Chronic kidney disease in children: an update

Chronic kidney disease in children: an update

Investigating the use of finerenone in children with chronic kidney disease and proteinuria: design of the FIONA and open-label extension studies

Protein Biomarkers in Chronic Kidney Disease in Children—What Do We Know So Far?

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