Common Modifiable Comorbidities in Children and CKD

Children with chronic kidney disease (CKD) face comorbidities that may require complex management. Yunwen Xu, MD, and colleagues reported treatment patterns for common modifiable CKD complications according to disease severity. The complications of interest were high blood pressure, anemia, hyperphosphatemia, and acidosis. The researchers also sought to identify factors associated with the absence of drug therapy in children with a persistent comorbidity enrolled in the CKiD (Chronic Kidney Disease in Children) study. The analysis was reported online in Pediatric Nephrology [doi.org/10.1007/s00467-021-05087-8].

The analysis included 703 CKiD participants, representing 2849 person-visits over a median follow-up of 3.5 years. The researchers used pairs of annual visits to examine whether participants with abnormal biomarker levels at the index visit persisted in the abnormal levels 1 year later; participants were stratified according to CKD risk stage. Demographic and clinical factors associated with the absence of drug therapy in the group with persistent comorbid conditions for 1 year were identified using multivariate analyses.

At the 1-year follow-up, the overall proportions of person-visits that prescribed therapy for treating anemia, acidosis, hyperphosphatemia, and high blood pressure were 54%, 45%, 29%, and 81%, respectively. For all comorbidities, the frequency of therapy increased with advanced CKD risk stage. However, despite the persistence of abnormal levels of biomarkers for acidosis, anemia, and hyperphosphatemia, 19-23% of those with acidosis, 24-27% with anemia, and 30-39% with hyperphosphatemia at high-risk stages E and F were not prescribed appropriate drug therapy, making the resolution of comorbidities at advanced CKD stages unlikely.

In summary, the researchers said, “Many children with CKD in the CKiD cohort did not receive pharmacological treatment for common and persistent modifiable comorbidities, even in severe CKD risk stages.”