The association of adverse childhood experiences with the progression of chronic kidney disease in children: a CKiD pilot study.

BACKGROUND

Adverse Childhood Experiences (ACEs; personal exposures to serious life situations prior to age 18) have been linked to poor health outcomes in adults with chronic kidney disease (CKD), although their association with pediatric CKD has not yet been reported.

METHODS

We compared the prevalence of 5 ACEs in children 12 years and older enrolled in the Chronic Kidney Disease in Children (CKiD) study to that in healthy children from a national registry (2011-2012 National Survey of Children's Health, NSCH). We used a generalized gamma time-to-event model to compare CKD progression among CKiD participants who experienced 2 or more ACEs versus those who did not.

RESULTS

The study cohort comprised 350 children with mild to moderate CKD. The majority of ACEs were noted at a higher prevalence in the CKiD cohort compared to the average national population (P < 0.05). Furthermore, CKiD participants with 2 or more ACEs experienced faster disease progression (P = 0.02).

CONCLUSIONS

Aggregate ACEs are associated with mild to moderate CKD and faster disease progression after adjustment for traditional risk factors. Further characterization of all potential ACE exposures in children with CKD is recommended; thus, intervention strategies can be designed to mediate their harmful impact on this highly vulnerable population.