Geylis Michael, Coreanu Tara, Novack Victor, Landau Daniel
Department of Pediatrics, Soroka University Medical Center, 151 Rager Boulevard, 84101, Beer-Sheva, Israel.
Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
Pediatr Nephrol. 2023 May;38(5):1569-1576. doi: 10.1007/s00467-022-05714-y. Epub 2022 Aug 26.
The population-based prevalence and risk factors of childhood chronic kidney disease (CKD) are not well-defined. We ascertained childhood CKD epidemiology and perinatal risk factors, based on a large computerized medical record database that covers most of southern Israel's population.
Pre- and post-natal records of 79,374 eligible children (with at least one serum creatinine test) born during 2001-2015 were analyzed. "Ever-CKD" was defined as ≥ 2 estimated glomerular filtration rate (eGFR) values < 60 ml/min/1.73 m beyond age 2 years, more than 3 months apart. The last CKD status was determined on March 2019.
Of 82 (0.1%) patients with ever-CKD, 35 (42.7%) had their first abnormal eGFR identified already at age 2 years. In multiple logistic regression analysis, congenital anomalies of kidney and urinary tract (CAKUT)-related diagnoses, glomerulopathy, maternal oligohydramnios, small for gestational age, prematurity (under 34 weeks), post-term delivery, and small for gestational age at birth were significant risk factors for ever-CKD (odds ratio (95% confidence interval): 44.34(26.43-74.39), 64.60(32.42-128.70), 5.54(3.01-10.19), 2.02(1.25-3.28), 4.45(2.13-9.28), 2.96(1.28-6.86 and 2.02(1.25-3.28), respectively). Seventy children with ever-CKD (85.4%) had a depressed eGFR (< 90 ml/min/1.73 m) on the last assessment (current-CKD), yielding a prevalence of 882/million.
CKD is more prevalent among children in southern Israel than previously reported, even after excluding those with aborted-CKD. Prenatal conditions increase the risk to develop CKD in childhood. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
儿童慢性肾脏病（CKD）基于人群的患病率及危险因素尚不清楚。我们基于一个覆盖以色列南部大部分人口的大型计算机化医疗记录数据库，确定了儿童CKD的流行病学情况及围产期危险因素。
对2001年至2015年期间出生的79374名符合条件的儿童（至少进行过一次血清肌酐检测）的产前和产后记录进行分析。“曾经患CKD”定义为2岁以后估算肾小球滤过率（eGFR）值≥2次<60 ml/min/1.73 m²，且间隔超过3个月。最后一次CKD状态确定于2019年3月。
在82名（0.1%）曾经患CKD的患者中，35名（42.7%）在2岁时就首次发现eGFR异常。在多因素logistic回归分析中，与肾和尿路先天性异常（CAKUT）相关的诊断、肾小球病、母亲羊水过少、小于胎龄儿、早产（34周以下）、过期产以及出生时小于胎龄儿是曾经患CKD的显著危险因素（比值比（95%置信区间）：分别为44.34（26.43 - 74.39）、64.60（32.42 - 128.70）、5.54（3.01 - 10.19）、2.02（1.25 - 3.28）、4.45（2.13 - 9.28）、2.96（1.28 - 6.86）和2.02（1.25 - 3.28））。70名曾经患CKD的儿童（85.4%）在最后一次评估时eGFR降低（<90 ml/min/1.73 m²）（当前患CKD），患病率为882/百万。
即使排除那些已终止的CKD病例，以色列南部儿童中CKD的患病率仍高于先前报道。产前状况会增加儿童患CKD的风险。图形摘要 可获取更高分辨率版本的图形摘要作为补充信息。
