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Regev-Epstein LC, Frishberg Y, Davidovits M, Landau D, Magen D, Weismann I, Stern-Zimmer M, Beckerman P, Keinan-Boker L, Calderon-Margalit R, Vivante A. Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons. Clin J Am Soc Nephrol 2023; 18:363-373. [PMID: 36722361 PMCID: PMC10103217 DOI: 10.2215/cjn.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pretransplant course of the entire Israeli pediatric kidney failure population over 30 years. METHODS In this nationwide, population-based, historical cohort study, we analyzed medical and demographic data of all children treated with KRT and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity, and calendar year, using the appropriate age-related general population as denominator. RESULTS During the last 30 years, childhood incidence of kidney failure decreased. Average incidence in 2015-2019 was 9.1 cases per million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews). The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract (approximately 27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type 1 (33%). Israel's national health insurance provides access to primary health care to all citizens. Accordingly, waiting time for deceased-donor transplantation was equal between all ethnicities. Living-donor kidney transplantation rates among minority populations remained low in comparison with Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent. CONCLUSIONS In Israel, Arab and Druze children had a higher incidence of kidney failure, a unique etiological distribution, and a lower rate of living-donor kidney transplantations compared with Jewish children.
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Affiliation(s)
- Lilach C. Regev-Epstein
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniella Magen
- Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weismann
- Pediatric Nephrology Unit, Galilee Medical Center, Nahariya, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Pazit Beckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ramat Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | | | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Geylis M, Coreanu T, Novack V, Landau D. Risk factors for childhood chronic kidney disease: a population-based study. Pediatr Nephrol 2022; 38:1569-1576. [PMID: 36018434 DOI: 10.1007/s00467-022-05714-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/22/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
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. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michael Geylis
- Department of Pediatrics, Soroka University Medical Center, 151 Rager Boulevard, 84101, Beer-Sheva, Israel. .,Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
| | - Tara Coreanu
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Daniel Landau
- Department of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Evaluation of insertion/deletion (I/D) polymorphisms of ACE gene and circulating levels of angiotensin II in congenital anomalies of the kidney and urinary tract. Mol Biol Rep 2022; 49:4341-4347. [PMID: 35212925 DOI: 10.1007/s11033-022-07269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) are defined as a heterogeneous group of anomalies that resulted from defects in kidney and urinary tract embryogenesis. CAKUT have a complex etiology. Genetic, epigenetic and environmental factors have been investigated in this context. Angiotensin II is a potent vasoconstrictor and exerts an important role in kidney embryogenesis. The angiotensin-converting enzyme (ACE) converts Angiotensin I into Angiotensin II (Ang II) and ACE gene has insertion/deletion (I/D) polymorphisms that have been evaluated in several nephropathies. This study aimed to evaluate whether the I/D polymorphisms of ACE gene and the circulating levels of Ang II are associated with any CAKUT phenotype or CAKUT in general. METHODS AND RESULTS Our study was performed with 225 pediatric patients diagnosed with CAKUT and 210 age-and-sex matched healthy controls. ACE I/D alleles were analysed by real-time polymerase chain reaction (RT-PCR). The distribution of ACE I/D polymorphisms were compared between CAKUT patients and healthy controls, as well between ureteropelvic junction obstruction (UPJO), vesicoureteral reflux (VUR), multicystic dysplastic kidney (MCDK) phenotypes and control group. No statistical association was detected between ACE I/D polymorphism and CAKUT and UPJO, VUR, and MCDK phenotypes. In a subset of 80 CAKUT patients and 80 controls, plasma levels of Ang II were measured. No significant differences were found between CAKUT patients and controls, even in regard to comparisons of UPJO, VUR and MCDK with control group. CONCLUSION Although CAKUT is a complex disease and the ACE gene may exert a role in kidney embryogenesis, CAKUT was not associated with any ACE I/D polymorphisms nor with differences in plasma levels of Ang II in this Brazilian pediatric population.
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Landau D, Schreiber R, Kleinman A, Vodonos A, Shalev H. Pediatric chronic kidney disease rates in Southern Israel are higher than reported. F1000Res 2014; 2:186. [PMID: 24555088 PMCID: PMC3829122 DOI: 10.12688/f1000research.2-186.v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2013] [Indexed: 11/20/2022] Open
Abstract
Background: The incidence and prevalence of pediatric chronic kidney disease (p-CKD) in developed countries has previously been estimated to be 12 and 75 cases/10
6 population respectively, much lower than reports in young adults (age 20-40) (40,000/10
6). Thus, the extent of p-CKD may be underestimated. Methods: Being the only Pediatric Nephrology center in Southern Israel, we reviewed all detected cases of p-CKD (stages 1-5) between 1994-2008. We then prospectively summarized the incidence and prevalence of CKD between 2009-2010. Results: We retrospectively identified 192 children (53.9% of Bedouin origin, 53.4% males, median diagnosis age: 1 year) with CKD. The prevalence in December 2008 was 795 cases/10
6 for all CKD stages and 331/10
6 for CKD stage >2. Calculated incidence for the study period (1994-2008) was 46/10
6/year. The main CKD etiologies were: hypodysplasia: 35%; obstructive uropathy: 13%; genetic renal diseases: 28% and glomerulonephritis: 15%. The proportions of children in each CKD stage were as follows: stage 1: 50%; stages 2-4: 30%; stage 5: 20%. During a subsequent two-year study period we identified 26 new CKD cases (incidence: 54 cases/10
6/year). Conclusions: p-CKD rates in our area are higher than reported and maybe even higher if asymptomatic populations are screened. Fifty percent of detected cases have CKD stage 1. This may contribute significantly to CKD beyond the pediatric age.
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Affiliation(s)
- Daniel Landau
- Pediatric Nephrology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Ruth Schreiber
- Pediatric Nephrology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Anya Kleinman
- Pediatric Nephrology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Alina Vodonos
- Clinical Research Center, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Hannah Shalev
- Pediatric Nephrology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
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