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2024, Number 6

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Rev Mex Pediatr 2024; 91 (6)

Risk factors associated with renal function deterioration in children with chronic kidney disease: a one-year follow-up analysis

Vadillo-Sáenz LC, Zurita-Cruz JN, Zepeda-Martínez CC, Alegría-Torres GA

Language: Spanish
References: 18
Page: 228-234
PDF size: 356.81 Kb.


ABSTRACT

Introduction: chronic kidney disease (CKD) is a progressive and irreversible condition that impairs renal function. Research has shown an average annual decline in glomerular filtration rate (GFR) of approximately 5 mL/min/1.73 m2, influenced by factors such as hypertension, proteinuria, anemia, and recurrent urinary tract infections. Objective: to describe the rate of renal function decline over one year of follow-up in pediatric patients with chronic kidney disease (CKD), and to identify risk factors associated with decreased glomerular filtration rate (GFR). Material and methods: a retrospective cohort study was conducted, including patients aged 2 to 16 years diagnosed with CKD stages 2, 3, and 4. Demographic, anthropometric, biochemical, and GFR data were collected at the initial consultation. The rate of GFR decline was assessed after 12 months of follow-up. Risk factors were compared between patients with and without significant GFR decline. Statistical analyses included the χ2 test, Fisher's exact test, Mann-Whitney U test, and multivariate logistic regression. Results: a total of 70 patients were included, with a median age of 11 years. After one year, 70% of patients showed a decline in renal function, with the most pronounced deterioration observed in those with glomerulopathy (100%). The fastest progression occurred in patients with stage 2 CKD. Proteinuria, hypertension and hyperphosphatemia were identified as significant risk factors for renal deterioration in the multivariate analysis. Conclusions: proteinuria, hypertension and hyperphosphatemia are associated with greater GFR decline in children with CKD. Additionally, CKD secondary to glomerulopathy and vascular disease appears to be a predictor of renal function deterioration.


REFERENCES

  1. Chan JC, Williams DM, Roth KS. Kidney failure in infants and children. Pediatr Rev. 2002; 23(2): 47-60. doi: 10.1542/pir.23-2-47.

  2. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014; 63(5): 713-735. doi: 10.1053/j.ajkd.2014.01.416.

  3. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012; 27(3): 363-373. doi: 10.1007/s00467-011-1939-1. Erratum in: Pediatr Nephrol. 2012; 27(3): 507.

  4. Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003; 111(4 Pt 1): e382-387. doi: 10.1542/peds.111.4.e382.

  5. Amanullah F, Malik AA, Zaidi Z. Chronic kidney disease causes and outcomes in children: perspective from a LMIC setting. PLoS One. 2022; 17(6): e0269632. doi: 10.1371/journal.pone.0269632.

  6. North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2008 Annual Report, Rockville EMMES, 2025. Available in: https://naprtcs.org/system/files/2008_Annual_CKD_Report.pdf

  7. National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 2016 Annual Report. ESRD among children, adolescents and Young adults, 2025. Available in: https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/usrds/prior-data-reports/2016

  8. González CC, Bitsori M, Tullus K. Progression of chronic renal failure in children with dysplastic kidneys. Pediatr Nephrol. 2007; 22(7): 1014-1020. doi: 10.1007/s00467-007-0459-5.

  9. Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G et al. Design and methods of the chronic kidney disease in children (CKiD) prospective cohort study. Clin J Am Soc Nephrol. 2006; 1(5): 1006-1015. doi: 10.2215/CJN.01941205.

  10. Staples AO, Greenbaum LA, Smith JM, Gipson DS, Filler G, Warady BA et al. Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol. 2010; 5(12): 2172-219. doi: 10.2215/CJN.07851109.

  11. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE et al. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003; 139(4): 244-252. doi: 10.7326/0003-4819-139-4-200308190-00006.

  12. ESCAPE Trial Group; Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009; 361(17): 1639-1650. doi: 10.1056/NEJMoa0902066.

  13. Ardissino G, Testa S, Dacco V, Vigano S, Taioli E, Claris-Appiani A et al. Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy. Data from the Ital Kid Project. Pediatr Nephrol. 2004; 19(2): 172-177. doi: 10.1007/s00467-003-1268-0.

  14. Warady BA, Abraham AG, Schwartz GJ, Wong CS, Muñoz A, Betoko A et al. Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: the chronic kidney disease in children (CKiD) Cohort. Am J Kidney Dis. 2015; 65(6): 878-888. doi: 10.1053/j.ajkd.2015.01.008.

  15. Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European study group of nutritional treatment of chronic renal failure in childhood. Lancet. 1997; 349(9059): 1117-1123. doi: 10.1016/s0140-6736(96)09260-4.

  16. Litwin M. Risk factors for renal failure in children with non-glomerular nephropathies. Pediatr Nephrol. 2004; 19(2): 178-186. doi: 10.1007/s00467-003-1329-4.

  17. Mitsnefes M, Ho PL, McEnery PT. Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol. 2003; 14(10): 2618-2622. doi: 10.1097/01.asn.0000089565.04535.4b.

  18. Voormolen N, Noordzij M, Grootendorst DC, Beetz I, Sijpkens YW, van Manen JG et al. High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients. Nephrol Dial Transplant. 2007; 22(10): 2909-2916. doi: 10.1093/ndt/gfm286.




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