Mild Dehydration and Risk of Childhood CKD Progression

Although children with CKD may be especially susceptible to dehydration, little research has been published regarding the frequency of dehydration and the risk of its complications in this population. Researchers, including Amelia K. Le Page, MBBS, FRACP, reviewed the risk factors and effects of mild dehydration and underhydration in CKD, focusing on its potential role in the risk of CKD progression.

The study authors acknowledge that analyzing dehydration in the CKD population is more challenging than in the healthy population, which complicates the definition of sufficient hydration and clinical research in this area. However, they reviewed pathophysiologic studies, which suggest that mild dehydration and underhydration can cause hyperfiltration injury and affect renal function. Arginine vasopressin is a key mediator of these risks.

Randomized, controlled trials in adults have not demonstrated that improved hydration affects CKD outcomes. However, more vulnerable populations with baseline low fluid intake or poor kidney concentrating capacity should be studied.

The authors suggest that routine pediatric CKD management should include an assessment of individual dehydration risk along with a treatment plan. However, they acknowledge a need for continued research.

Source: Pediatric Nephrology