Universidade do Estado do Amazonas, Manaus, AM, Brazil.
Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Rev Paul Pediatr. 2022 Apr 4;40:e2021057. doi: 10.1590/1984-0462/2022/40/2021057. eCollection 2022.
To describe the characteristics of stage-5 chronic kidney disease (CKD) children and adolescents undergoing renal replacement therapy (RRT) in Amazonas, Brazil, estimating the frequencies of current and new cases, describing the presence of anemia and bone metabolism disorders.
Thirty-five patients aged 7 to 19 years-old on hemodialysis (HD) or peritoneal dialysis (PD) were studied between June 2018 and April 2019. The frequencies of current and new cases were estimated based on the 0 to 19 years-old population of Amazonas, in the same period. Data were collected about the underlying cause and diagnosis of CKD, dialysis, and biochemical analysis.
The frequencies of current and new cases were 24 and 15 patients per million people of compatible age (pmpca), respectively. The causes of CKD were nephrotic syndrome (22.8%), nephritic syndrome (14.3%), and neurogenic bladder (14.3%); in 48.6%, the cause was unknown/not investigated. Ten patients underwent renal biopsy, seven with segmental and focal glomerulosclerosis. The majority (80%) were on HD, with an average kt/V of 1.4, and in 51.4% the vascular access was the double lumen catheter. Hypocalcemia was found in 82.8% of patients, hyperphosphatemia in 57.2%, vitamin D insufficiency or deficiency in 60%, and altered parathyroid hormone values in 48.6%. Hemoglobin was low in 80%, with absolute/functional iron deficiency in 28.6%.
In children and adolescents of Amazonas, Brazil, we found 24 pmpca with stage-5 CKU currently in RRT and 16.3 pmpca per year of new cases requiring RRT. Most patients were adolescents on HD, half without a causal diagnosis of CKD, with a high frequency of anemia and bone metabolism disorder.
描述巴西亚马孙地区接受肾脏替代治疗（RRT）的 5 期慢性肾脏病（CKD）儿童和青少年的特征，估计现患和新发病例的频率，描述贫血和骨代谢紊乱的发生情况。
2018 年 6 月至 2019 年 4 月，对 35 名年龄在 7 至 19 岁之间的接受血液透析（HD）或腹膜透析（PD）的患者进行了研究。根据同期亚马孙地区 0 至 19 岁人群，估计了现患和新发病例的频率。收集了与 CKD 病因和诊断、透析和生化分析有关的数据。
现患和新发病例的频率分别为每百万同龄人口 24 例和 15 例（pmpca）。CKD 的病因包括肾病综合征（22.8%）、肾炎综合征（14.3%）和神经性膀胱（14.3%）；48.6%的病因不明/未调查。10 名患者接受了肾活检，其中 7 名患有节段性和局灶性肾小球硬化症。大多数患者（80%）接受 HD 治疗，平均 kt/V 为 1.4，51.4%的血管通路为双腔导管。82.8%的患者存在低钙血症，57.2%的患者存在高磷血症，60%的患者存在维生素 D 不足或缺乏，48.6%的患者存在甲状旁腺激素值改变。80%的患者血红蛋白水平较低，28.6%的患者存在绝对/功能性铁缺乏。
在巴西亚马孙地区的儿童和青少年中，我们发现目前有 24 例 pmpca 患有 5 期 CKU，每年有 16.3 例 pmpca 需要接受 RRT。大多数患者是接受 HD 治疗的青少年，一半没有 CKD 的病因诊断，贫血和骨代谢紊乱的发生率较高。
