Background

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.

Methods

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 m² beyond age 2 years, more than 3 months apart. The last CKD status was determined on March 2019.

Results

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 m²) on the last assessment (current-CKD), yielding a prevalence of 882/million.

Conclusions

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.

中文翻译：

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儿童慢性肾脏病的危险因素：一项基于人群的研究

背景

儿童慢性肾脏病 (CKD) 的人群患病率和危险因素尚不明确。我们根据涵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，确定了儿童期 CKD 流行病学和围产期危险因素。

方法

分析了 2001-2015 年间出生的 79,374 名符合条件的儿童（至少进行了一项血清肌酐测试）的产前和产后记录。“Ever-CKD”被定义为 ≥ 2 个估计的肾小球滤过率 (eGFR) 值 < 60 ml/min/1.73 m ²超过 2 岁，间隔超过 3 个月。最后一次 CKD 状态于 2019 年 3 月确定。

结果

在 82 名 (0.1%) 曾经患有 CKD 的患者中，有 35 名 (42.7%) 在 2 岁时首次发现异常 eGFR。在多元逻辑回归分析中，先天性肾脏和泌尿道异常 (CAKUT) 相关诊断、肾小球病、母体羊水过少、小于胎龄儿、早产（34 周以下）、过期分娩和出生时小于胎龄儿是曾经发生 CKD 的重要危险因素（比值比（95% 置信区间）：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（分别为 1.28–6.86 和 2.02（1.25–3.28））。70 名^曾经患有 CKD 的儿童 (85.4%)在上次评估（当前- CKD)，患病率为 882/百万。

结论

CKD 在以色列南部的儿童中比以前报道的更为普遍，即使在排除那些流产的 CKD 之后也是如此。产前状况会增加儿童期患 CKD 的风险。