Pediatric CKD: Comorbidities Include Anemia and Hypertension

Aakash Chandran Chidambaram, MD, and colleagues recently conducted a study designed to examine the etiology of pediatric chronic kidney disease (CKD). The researchers also sought to identify comorbidities associated with pediatric CKD, identify the rate of CKD progression, and risk factors. Results were reported in the Indian Journal of Pediatrics [doi:10.1007/s12098-022-04318-6].

The study cohort included children 2 to 18 years of age with Kidney Disease Improving Global Outcomes CKD stages 2 to 4. Time to progression of CKD was analyzed using Kaplan-Meier survival curves.

The cohort included 131 patients. Of those, 47.3% (n=62) had CKD stage 2, 13% (n=17) had CKD stage 3a, 19.8% (n=26) had CKD stage 3b, and 19.8% (n=26) had CKD stage 4. At the last follow-up (median 24 months), the corresponding percentages (numbers) of children in CKD stages 2, 3a, 3b, 4, and 5 were 36.6% (n=48), 12.2% (n=16), 17.6% (n=23), 21.4% (n=28), and 12.2% (n=16), respectively.

The predominant etiologies of CKD were obstructive uropathy (36.6%, n=48), chronic glomerular disease (14.5%, n=19), reflux nephropathy (10.7%, n=14), and cystic renal disease (8.3%, n=11). Comorbidities identified during follow-up were CKD-mineral bone disease (66.4%, n=87), metabolic acidosis (72.5%, n=95), hypertension (67.1%, n=88), growth retardation (52.6%, n=69), and anemia (48.1%, n=63). The number of patients with metabolic acidosis, hypertension, mineral bone disease, and anemia in CKD stage 2 was 27 (56%), 26 (54.2%), 24 (50%), and 15 (30%), respectively.

The median rate of decline in estimated glomerular filtration rate (eGFR) was 3.3 mL/min/1.73 m2 per year. Results of multivariable analysis identified proteinuria (hazard ratio [HR], 3.5; 95% CI, 1.4-8.8; P=.01) and hyperphosphatemia (HR, 2.2; 95% CI, 1.1-4.3; P=.003) as significant predictors for CKD progression.

In summary, the authors said, “Even the earlier stages of CKD had significant comorbidities. The median decline in eGFR was 3.3 mL/min/1.73 m2 per year. Proteinuria and hyperphosphatemia were the risk factors for progression of CKD.”