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van Zwieten A, Kim S, Dominello A, Guha C, Craig JC, Wong G. Socioeconomic Position and Health Among Children and Adolescents With CKD Across the Life-Course. Kidney Int Rep 2024; 9:1167-1182. [PMID: 38707834 PMCID: PMC11068961 DOI: 10.1016/j.ekir.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Children and adolescents in families of lower socioeconomic position (SEP) experience an inequitable burden of reduced access to healthcare and poorer health. For children living with chronic kidney disease (CKD), disadvantaged SEP may exacerbate their considerable disease burden. Across the life-course, CKD may also compromise the SEP of families and young people, leading to accumulating health and socioeconomic disadvantage. This narrative review summarizes the current evidence on relationships of SEP with kidney care and health among children and adolescents with CKD from a life-course approach, including impacts of family SEP on kidney care and health, and bidirectional impacts of CKD on SEP. It highlights relevant conceptual models from social epidemiology, current evidence, clinical and policy implications, and provides directions for future research. Reflecting the balance of available evidence, we focus primarily on high-income countries (HICs), with an overview of key issues in low- and middle-income countries (LMICs). Overall, a growing body of evidence indicates sobering socioeconomic inequities in health and kidney care among children and adolescents with CKD, and adverse socioeconomic impacts of CKD. Dedicated efforts to tackle inequities are critical to ensuring that all young people with CKD have the opportunity to live long and flourishing lives. To prevent accumulating disadvantage, the global nephrology community must advocate for local government action on upstream social determinants of health; and adopt a life-course approach to kidney care that proactively identifies and addresses unmet social needs, targets intervening factors between SEP and health, and minimizes adverse socioeconomic outcomes across financial, educational and vocational domains.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amanda Dominello
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Chandana Guha
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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2
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Gist KM, Menon S, Anton-Martin P, Bigelow AM, Cortina G, Deep A, De la Mata-Navazo S, Gelbart B, Gorga S, Guzzo I, Mah KE, Ollberding NJ, Shin HS, Thadani S, Uber A, Zang H, Zappitelli M, Selewski DT. Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults. JAMA Netw Open 2024; 7:e2349871. [PMID: 38165673 PMCID: PMC10762580 DOI: 10.1001/jamanetworkopen.2023.49871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/14/2023] [Indexed: 01/04/2024] Open
Abstract
Importance In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown. Objective To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90). Design, Setting, and Participants This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023. Exposure The primary exposure was time to CRRT initiation from intensive care unit admission. Main Outcomes and measures The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]). Results Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]). Conclusions and Relevance In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.
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Affiliation(s)
- Katja M Gist
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shina Menon
- Seattle Children's Hospital, University of Washington, Seattle
| | | | - Amee M Bigelow
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | | | - Akash Deep
- King's College Hospital, London, England
| | - Sara De la Mata-Navazo
- Gregorio Marañón University Hospital; Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ben Gelbart
- Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Gorga
- University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor
| | | | - Kenneth E Mah
- Stanford University School of Medicine, Palo Alto, California
| | - Nicholas J Ollberding
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H Stella Shin
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Sameer Thadani
- Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Amanda Uber
- University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha
- University of Utah, Primary Children's Hospital, Salt Lake City
| | - Huaiyu Zang
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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McCulloch MI, Argent AC, Morrow B, Nourse P, Coetzee A, Du Buisson C, Reddy D, Buckley J, Sinclair PJ, Gajjar P, Semanska L, Eddy A, Feehally J, Cano F, Warady BA. Lessons learned from regional training of paediatric nephrology fellows in Africa. Pediatr Nephrol 2023; 38:3757-3768. [PMID: 37278919 PMCID: PMC10243235 DOI: 10.1007/s00467-023-06022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Access to care for children with kidney disease is limited in less well-resourced regions of the world and paediatric nephrology (PN) workforce development with good practical skills is critical. METHODS Retrospective review of a PN training program and trainee feedback from 1999 to 2021, based at Red Cross War Memorial Children's Hospital (RCWMCH), University of Cape Town. RESULTS A regionally appropriate 1-2-year training program enrolled 38 fellows with an initial 100% return rate to their country of origin. Program funding included fellowships from the International Pediatric Nephrology Association (IPNA), International Society of Nephrology (ISN), International Society of Peritoneal Dialysis (ISPD), and the African Paediatric Fellowship Program (APFP). Fellows were trained on both in- and out-patient management of infants and children with kidney disorders. "Hands-on skills" training included examination, diagnosis and management skills, practical insertion of peritoneal dialysis catheters for management of acute kidney injury and kidney biopsies. Of 16 trainees who completed > 1 year of training, 14 (88%) successfully completed subspecialty exams and 9 (56%) completed a master's degree with a research component. PN fellows reported that their training was appropriate and enabled them to make a difference in their respective communities. CONCLUSIONS This training program has successfully equipped African physicians with the requisite knowledge and skills to provide PN services in resource-constrained areas for children with kidney disease. The provision of funding from multiple organizations committed to paediatric kidney disease has contributed to the success of the program, along with the fellows' commitment to build PN healthcare capacity in Africa. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mignon I McCulloch
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa.
| | - Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Peter Nourse
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Ashton Coetzee
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Christel Du Buisson
- Department of Paediatric Nephrology, Tygerberg Hospital Children's Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | - Deveshni Reddy
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Jonathan Buckley
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Paul J Sinclair
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Priya Gajjar
- Department of Paediatric Nephrology, Red Cross Children's Hospital, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Lucie Semanska
- International Pediatric Nephrology Association (IPNA) Office Administration, IPNA Programs Coordinator, Kansa City, MO, USA
| | - Allison Eddy
- Professor Emeritus (Pediatrics), The University of British Columbia|Musqueam Traditional Territory, Investigator, BC Children's Hospital Research Institute, Scientific & Research Staff, BC Children's Hospital, Vancouver, Canada
| | - John Feehally
- Emeritus Consultant Nephrologist, University Hospitals of Leicester, Honorary Visiting Fellow, Leicester, UK
| | - Francisco Cano
- Pediatric Nephrologist, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile
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Rybi Szumińska A, Wasilewska A, Kamianowska M. Protein Biomarkers in Chronic Kidney Disease in Children-What Do We Know So Far? J Clin Med 2023; 12:3934. [PMID: 37373629 DOI: 10.3390/jcm12123934] [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: 04/03/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) in children is a major concern of medical care and public health as it is related to high morbidity and mortality due to progression to end-stage kidney disease (ESKD). It is essential to identify patients with a risk of developing CKD to implement therapeutic interventions. Unfortunately, conventional markers of CKD, such as serum creatinine, glomerular filtration rate (GFR) and proteinuria, have many limitations in serving as an early and specific diagnostic tool for this condition. Despite the above, they are still the most frequently utilized as we do not have better. Studies from the last decade identified multiple CKD blood and urine protein biomarkers but mostly assessed the adult population. This article outlines some recent achievements and new perspectives in finding a set of protein biomarkers that might improve our ability to prognose CKD progression in children, monitor the response to treatment, or even become a potential therapeutic target.
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Affiliation(s)
- Agnieszka Rybi Szumińska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Anna Wasilewska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Monika Kamianowska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
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Alvarez-Elías AC, Lou-Meda R, Exeni R, Exantus J, Bonilla-Felix M, González-Camac S, de Ferris MEDG. Addressing Health Inequities and Disparities in Children With Kidney Disease in Disadvantaged Areas: the Latin American and Caribbean Experience. CURRENT PEDIATRICS REPORTS 2023; 11:40-49. [PMID: 37252328 PMCID: PMC10206370 DOI: 10.1007/s40124-023-00287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Purpose of Review Compared with high-income countries, healthcare disparities and inequities are more evident in low, lower-middle, and upper-middle-income countries with poorer housing and nutrition conditions. At least 20% of Latin America and the Caribbean are low and lower-middle-income countries. Despite the majority of the other countries being upper-middle income, the United Nations Children's Fund had classified all the regions as "less developed," with limited access to health care for the most vulnerable, the children. Latin America and the Caribbean regions represent an extensive territory with communication limitations and an unstable socio-political and economic environment. After considering the vast population affected by poverty worldwide and the long-term impact of kidney disease starting in childhood, it is crucial to better understand and analyze the multifactorial limiting conditions in accessing specialized care such as pediatric nephrology in disadvantaged areas. Recent Findings Constraints in accessing basic healthcare in rural areas make it impossible to receive specialized pediatric nephrology care including dialysis and transplantation. Disturbingly, incidence and prevalence figures of acute kidney injury, chronic and end-stage kidney disease in some Latin American and the Caribbean countries are unknown, and these conditions still represent a death sentence for underprivileged populations. However, the monumental efforts of the dedicated healthcare providers and stakeholders that pioneered the actions in the past 50 years have shown remarkable progress in developing pediatric nephology services across the continent. Summary In this review, we compile some of the latest evidence about the care of children and adolescents with kidney conditions in Latin America and the Caribbean, along with the experiences from the field in the care of these patients facing adverse conditions. We also highlight recommendations to address inequities and disparities.
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Affiliation(s)
- Ana Catalina Alvarez-Elías
- Division of Nephrology, Research Institute, Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4 Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Departamento de Investigacion Clinica, Hospital Infantil de México, Federico Gómez, UNAM, Ciudad de Mexico, México
| | - Randall Lou-Meda
- Division of Nephrology, Hospital Roosevelt, Ciudad de Guatemala, Guatemala
- Fundación Para El Niño Enfermo Renal (FUNDANIER), Ciudad de Guatemala, Guatemala
| | - Ramón Exeni
- Division of Nephrology, Hospital Profesor Doctor Ramón Exeni, Buenos Aires, Argentina
| | - Judith Exantus
- Pediatrics Unit, State University Hospital, University of Haiti, Port-Au-Prince, Haiti
| | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Saúl González-Camac
- Division de Nefrologia y Trasplante, Instituto Nacional de Salud del Niño, San Borja, Lima, Peru
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Kitzler TM, Chun J. Understanding the Current Landscape of Kidney Disease in Canada to Advance Precision Medicine Guided Personalized Care. Can J Kidney Health Dis 2023; 10:20543581231154185. [PMID: 36798634 PMCID: PMC9926383 DOI: 10.1177/20543581231154185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/19/2022] [Indexed: 02/15/2023] Open
Abstract
Purpose of Review To understand the impact of kidney disease in Canada and the priority areas of kidney research that can benefit from patient-oriented, precision medicine research using novel technologies. Sources of Information Information was collected through discussions between health care professionals, researchers, and patient partners. Literature was compiled using search engines (PubMed, PubMed central, Medline, and Google) and data from the Canadian Organ Replacement Register. Methods We reviewed the impact, prevalence, economic burden, causes of kidney disease, and priority research areas in Canada. After reviewing the priority areas for kidney research, potential avenues for future research that can integrate precision medicine initiatives for patient-oriented research were outlined. Key Findings Chronic kidney disease (CKD) remains among the top causes of morbidity and mortality in the world and exerts a large financial strain on the health care system. Despite the increasing number of people with CKD, funding for basic kidney research continues to trail behind other diseases. Current funding strategies favor existing clinical treatment and patient educational strategies. The identification of genetic factors for various forms of kidney disease in the adult and pediatric populations provides mechanistic insight into disease pathogenesis. Allocation of resources and funding toward existing high-yield personalized research initiatives have the potential to significantly affect patient-oriented research outcomes but will be difficult due to a constant decline of funding for kidney research. Limitations This is an overview primarily focused on Canadian-specific literature rather than a comprehensive systematic review of the literature. The scope of our findings and conclusions may not be applicable to health care systems in other countries.
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Affiliation(s)
- Thomas M. Kitzler
- Division of Medical Genetics, Department of Specialized Medicine, McGill University Health Centre, Montreal, QC, Canada,Department of Human Genetics, McGill University, Montreal, QC, Canada,Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Justin Chun
- Department of Medicine, Cumming School of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, AB, Canada,Justin Chun, Division of Nephrology, Department of Medicine, University of Calgary, Health Research Innovation Centre, 4A12, 3280 Hospital Drive Northwest, Calgary, AB T2N 4Z6, Canada.
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What is the true burden of chronic kidney disease in children worldwide? Pediatr Nephrol 2022; 38:1389-1393. [PMID: 36409363 DOI: 10.1007/s00467-022-05816-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022]
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Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatr Nephrol 2022; 37:959-972. [PMID: 33839937 DOI: 10.1007/s00467-021-05059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nearly 50% of the world population and 60% of children aged 0 to 14 years live in low- or lower-middle-income countries. Paediatric nephrology (PN) in these countries is not a priority for allocation of limited health resources. This article explores advancements made and persisting limitations in providing optimal PN services to children in such under-resourced areas (URA). METHODS Medline, PubMed and Google Scholar online databases were searched for articles pertaining to PN disease epidemiology, outcome, availability of services and infrastructure in URA. The ISN and IPNA offices were contacted for data, and two online questionnaire surveys of IPNA membership performed. Regional IPNA members were contacted for further detailed information. RESULTS There is a scarcity of published data from URA; where available, prevalence of PN diseases, managements and outcomes are often reported to be different from high income regions. Deficiencies in human resources, fluoroscopy, nuclear imaging, immunofluorescence, electron microscopy and genetic studies were identified. Several drugs and maintenance kidney replacement therapy are inaccessible to the majority of patients. Despite these issues, regional efforts with support from international bodies have led to significant advances in PN services and infrastructure in many URA. CONCLUSIONS Equitable distribution and affordability of PN services remain major challenges in URA. The drive towards acquisition of regional data, advocacy to local government and non-government agencies and partnership with international support bodies needs to be continued. The aim is to optimise and achieve global parity in PN training, investigations and treatments, initially focusing on preventable and reversible conditions.
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Affiliation(s)
| | | | - Sampson Antwi
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Abstract
Major advances have been made in the management of children with chronic kidney disease over the past 30 years. However, existing epidemiology data are primarily from kidney replacement therapy registries, and information available at earlier stages of chronic kidney disease is limited. The incidence and prevalence of chronic kidney disease stages 2 to 5 remain poorly understood. However, rare population-based studies suggest that the prevalence of all-stage chronic kidney disease may be as high as 1% of the pediatric population. Congenital disorders including congenital abnormalities of the kidney and urinary tract and hereditary nephropathies account for one-half to two-thirds of pediatric chronic kidney disease cases in middle and high-income countries, whereas acquired nephropathies seem to predominate in low-income countries. The progression of chronic kidney disease is slower in children with congenital disorders than in those with acquired nephropathy, particularly glomerular disease, resulting in a lower proportion of congenital abnormalities of the kidney and urinary tract as a cause of end-stage kidney disease compared to less advanced stages of chronic kidney disease. The incidence of kidney replacement therapy in the pediatric population ranged by country from 1 to 14 per million children of the same age in 2018 (approximately 8 per million children in France) in patients younger than 20 years. The prevalence of kidney replacement therapy in children under 20 years of age in 2018 ranged from 15-30 per million children in some Eastern European and Latin American countries to 100 per million children in Finland and the United States (56 per million children in France). Most children with end-stage kidney disease initiate kidney replacement therapy with dialysis (more frequently hemodialysis than peritoneal dialysis). In about 20% of cases, the initial kidney replacement therapy modality is a pre-emptive kidney transplantation. In high-income countries, 60-80% of prevalent children with end-stage kidney disease live with a functioning transplant (75% in France). While the survival of children with chronic kidney disease has continuously improved over time, mortality remains about 30 times higher than in the general pediatric population.
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Affiliation(s)
- Jérôme Harambat
- Unité de néphrologie pédiatrique, hôpital Pellegrin-Enfants, Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France.
| | - Iona Madden
- Unité de néphrologie pédiatrique, hôpital Pellegrin-Enfants, Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Julien Hogan
- Service de néphrologie pédiatrique, hôpital Robert Debré, APHP, 48, boulevard Sérurier, 75019 Paris, France; Université Sorbonne Paris Cité, 48, boulevard Sérurier, 75019 Paris, France
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Borzych-Dużałka D, Schaefer F, Warady BA. Targeting optimal PD management in children: what have we learned from the IPPN registry? Pediatr Nephrol 2021; 36:1053-1063. [PMID: 32458134 PMCID: PMC8009785 DOI: 10.1007/s00467-020-04598-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022]
Abstract
National and international registries have great potential for providing data that describe disease burden, treatments, and outcomes especially in rare diseases. In the setting of pediatric end-stage renal disease (ESRD), the available data are limited to highly developed countries, whereas the lack of data from emerging economies blurs the global perspective. In order to improve the pediatric dialysis care worldwide, provide global benchmarking of pediatric dialysis outcome, and assign useful tools and management algorithms based on evidence-based medicine, the International Pediatric Peritoneal Dialysis Network (IPPN) was established in 2007. In recent years, the Registry has provided comprehensive data on relevant clinical issues in pediatric peritoneal dialysis patients including nutritional status, growth, cardiovascular disease, anemia management, mineral and bone disorders, preservation of residual kidney function, access-related complications, and impact of associated comorbidities. A unique feature of the registry is the ability to compare practices and outcomes between countries and world regions. In the current review, we describe study design and collection methods, summarize the core IPPN findings based on its 12-year experience and 13 publications, and discuss the future perspective.
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Affiliation(s)
- Dagmara Borzych-Dużałka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland.
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Ploos van Amstel S, Noordzij M, Borzych-Duzalka D, Chesnaye NC, Xu H, Rees L, Ha IS, Antonio ZL, Hooman N, Wong W, Vondrak K, Yap YC, Patel H, Szczepanska M, Testa S, Galanti M, Kari JA, Samaille C, Bakkaloglu SA, Lai WM, Rojas LF, Diaz MS, Basu B, Neu A, Warady BA, Jager KJ, Schaefer F. Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric Peritoneal Dialysis Network Registry. Am J Kidney Dis 2021; 78:380-390. [PMID: 33549627 DOI: 10.1053/j.ajkd.2020.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017. EXPOSURE Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 income groups based on gross national income) factors also were studied. OUTCOME All-cause MPD mortality. ANALYTICAL APPROACH Patients were observed for 3 years, and the mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates. RESULTS A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After 3 years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%). LIMITATIONS The interpretation of interregional survival differences as found in this study may be hampered by selection bias. CONCLUSIONS This study shows that the overall 3-year patient survival on pediatric MPD is high, and that country income is associated with patient survival.
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Affiliation(s)
- Sophie Ploos van Amstel
- IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marlies Noordzij
- IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Dagmara Borzych-Duzalka
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany; Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Nicholas C Chesnaye
- IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hong Xu
- Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Lesley Rees
- Great Ormond Street Hospital, London, United Kingdom
| | - Il-Soo Ha
- Pediatrics Seoul, National University Children's Hospital, Seoul, South Korea
| | - Zenaida L Antonio
- Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | | | - Yok Chin Yap
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Hiren Patel
- Nationwide Children's Hospital, Columbus, OH
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Sara Testa
- Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Charlotte Samaille
- Service de Néphrologie Pédiatrique, Hôpital Jeanne De Flandre, Lille, France
| | - Sevcan A Bakkaloglu
- Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey
| | - Wai-Ming Lai
- Department of Paediatric & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | | | | | | | - Alicia Neu
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Kitty J Jager
- IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
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12
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Chandar J, Chen L, Defreitas M, Ciancio G, Burke G. Donor considerations in pediatric kidney transplantation. Pediatr Nephrol 2021; 36:245-257. [PMID: 31932959 DOI: 10.1007/s00467-019-04362-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 01/10/2023]
Abstract
This article reviews kidney transplant donor options for children with end-stage kidney disease (ESKD). Global access to kidney transplantation is variable. Well-established national policies, organizations for organ procurement and allocation, and donor management policies may account for higher deceased donor (DD transplants) in some countries. Living donor kidney transplantation (LD) predominates in countries where organ donation has limited national priority. In addition, social, cultural, religious and medical factors play a major role in both LD and DD kidney transplant donation. Most children with ESKD receive adult-sized kidneys. The transplanted kidney has a finite survival and the expectation is that children who require renal replacement therapy from early childhood will probably have 2 or 3 kidney transplants in their lifetime. LD transplant provides better long-term graft survival and is a better option for children. When a living related donor is incompatible with the intended recipient, paired kidney exchange with a compatible unrelated donor may be considered. When the choice is a DD kidney, the decision-making process in accepting a donor offer requires careful consideration of donor history, kidney donor profile index, HLA matching, cold ischemia time, and recipient's time on the waiting list. Accepting or declining a DD offer in a timely manner can be challenging when there are undesirable facts in the donor's history which need to be balanced against prolonging dialysis in a child. An ongoing global challenge is the significant gap between organ supply and demand, which has increased the need to improve organ preservation techniques and awareness for organ donation.
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Affiliation(s)
- Jayanthi Chandar
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami Transplant Institute, PO Box 016960 (M714), Miami, FL, 33101, USA.
| | - Linda Chen
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
| | - Marissa Defreitas
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami Transplant Institute, PO Box 016960 (M714), Miami, FL, 33101, USA
| | - Gaetano Ciancio
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
| | - George Burke
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
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13
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Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int 2021; 100:182-195. [PMID: 33359055 DOI: 10.1016/j.kint.2020.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure.
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14
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Bamford A, Dixon G, Klein N, Marks SD, Ritz N, Welch SB, Tebruegge M. Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Pediatr Nephrol 2021; 36:3023-3031. [PMID: 33245418 PMCID: PMC8445864 DOI: 10.1007/s00467-020-04844-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease.
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Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - Garth Dixon
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatirc Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nigel Klein
- grid.424537.30000 0004 5902 9895Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen D. Marks
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicole Ritz
- grid.6612.30000 0004 1937 0642University of Basel Children’s Hospital, Paediatric Infectious Disease and Vaccinology Department, Migrant Health Service, Basel, Switzerland ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Steven B. Welch
- grid.412563.70000 0004 0376 6589Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Marc Tebruegge
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia ,grid.420545.2Department of Paediatric Infectious Diseases & Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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15
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Zhai Y, Liu X, Yang Q, Dang X, Sun S, Shao X, Liu X, Wu Y, Bai H, Mao J, Dong Y, Ma Q, Kang G, Huang W, Zhu H, Fu R, Zhang A, Xu R, Sun Q, Jiang X, Lai L, Huang J, Luan J, Xia Z, Cui J, Zhao M, Wu X, Zhang Q, Li Y, Liu C, Wang M, Wang F, Tao Y, Huang Z, Zhang D, Zhao B, Chen C, Huang C, Gao X, Shen Q, Shen Y, Xu H. IPDN-China promotes the development of pediatric dialysis in China. Pediatr Nephrol 2020; 35:2163-2171. [PMID: 32529322 DOI: 10.1007/s00467-020-04630-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. METHODS Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. RESULTS Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). CONCLUSIONS The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.
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Affiliation(s)
- Yihui Zhai
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China
| | - Xiaorong Liu
- Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China
| | - Qing Yang
- Division of Nephrology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiqiang Dang
- Division of Pediatric Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shuzhen Sun
- Division of Pediatric Nephrology, Shandong Provincial Hospital, Jinan, China
| | - Xiaoshan Shao
- Division of Nephrology, Guiyang Children's Hospital, Guiyang, China
| | - Xuemei Liu
- Division of Nephrology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Yubin Wu
- Division of Pediatric Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haitao Bai
- Division of Pediatric Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jianhua Mao
- Division of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Dong
- Division of Nephrology, Anhui Provincial Children's Hospital, Hefei, China
| | - Qingshan Ma
- Division of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Guogui Kang
- Division of Pediatric Nephrology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Wenyan Huang
- Division of Nephrology, Shanghai Children's Hospital, Shanghai, China
| | - Hongtao Zhu
- Division of Pediatric Nephrology, The First Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Fu
- Division of Nephrology, Jiangxi Children's Hospital, Nanchang, China
| | - Aihua Zhang
- Division of Nephrology, Nanjing Children's Hospital, Nanjing, China
| | - Ruiying Xu
- Division of Pediatric Nephrology, Qilu Hospital of Shandong University, Jinan, China
| | - Qing Sun
- Division of Pediatric Nephrology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Xiaoyun Jiang
- Division of Pediatric Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liwen Lai
- Division of Pediatric Nephrology, The third People's Hospital of Jingdezhen, Nanchang, China
| | - Jianping Huang
- Division of Nephrology, Bayi Children's Hospital, The Military General Hospital of Beijing PLA, Beijing, China
| | - Jiangwei Luan
- Division of Pediatric Nephrology, Wuhan Women and Children's Hospital, Wuhan, China
| | - Zhengkun Xia
- Division of Pediatric Nephrology, National Clinical Research Center of Kidney Disease, Jinlin Hospital, Nanjing, China
| | - Jianjun Cui
- Division of Nephrology, Shanxi Children's Hospital, Taiyuan, China
| | - Mengzhun Zhao
- Division of Pediatric Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaolin Wu
- Division of Pediatric Nephrology, Hubei Women and Children's Hospital, Wuhan, China
| | - Qiuye Zhang
- Division of Pediatric Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yufeng Li
- Division of Pediatric Nephrology, Xin Hua Hospital Affiliated, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuihua Liu
- Division of Nephrology, Henan Children's Hospital, Henan, China
| | - Mo Wang
- Division of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyan Wang
- Division of Nephrology, Urumqi Children's Hospital, Urumqi, China
| | - Yuhong Tao
- Division of Pediatric Nephrology, West China Second University Hospital, Chengdu, China
| | - Zhimin Huang
- Division of Pediatric Nephrology, The Affiliated Hospital of Guangdong University, Guangzhou, China
| | - Dongfeng Zhang
- Division of Nephrology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Bo Zhao
- Division of Nephrology, Kunming Children's Hospital, Kunming, China
| | - Chaoying Chen
- Division of Nephrology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Chunlin Huang
- Division of Nephrology, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xia Gao
- Division of Pediatric Nephrology, Gansu Provincial Hospital, Lanzhou, China
| | - Qian Shen
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China.
| | - Ying Shen
- Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China.
| | - Hong Xu
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China.
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16
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McCulloch M, Luyckx VA, Cullis B, Davies SJ, Finkelstein FO, Yap HK, Feehally J, Smoyer WE. Challenges of access to kidney care for children in low-resource settings. Nat Rev Nephrol 2020; 17:33-45. [PMID: 33005036 DOI: 10.1038/s41581-020-00338-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
Kidney disease is a global public health concern across the age spectrum, including in children. However, our understanding of the true burden of kidney disease in low-resource areas is often hampered by a lack of disease awareness and access to diagnosis. Chronic kidney disease (CKD) in low-resource settings poses multiple challenges, including late diagnosis, the need for ongoing access to care and the frequent unavailability of costly therapies such as dialysis and transplantation. Moreover, children in such settings are at particular risk of acute kidney injury (AKI) owing to preventable and/or reversible causes - many children likely die from potentially reversible kidney disease because they lack access to appropriate care. Acute peritoneal dialysis (PD) is an important low-cost treatment option. Initiatives, such as the Saving Young Lives programme, to train local medical staff from low-resource areas to provide care for AKI, including acute PD, have already saved hundreds of children. Future priorities include capacity building for both educational purposes and to provide further resources for AKI management. As local knowledge and confidence increase, CKD management strategies should also develop. Increased awareness and advocacy at both the local government and international levels will be required to continue to improve the diagnosis and treatment of AKI and CKD in children worldwide.
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Affiliation(s)
- Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Pediatric and Adult Renal Units, University of Cape Town, Cape Town, South Africa
| | - Brett Cullis
- Pediatric and Adult Renal Units, University of Cape Town, Cape Town, South Africa.,Nelson Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Hui Kim Yap
- Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - John Feehally
- International Society of Nephrology, Brussels, Belgium
| | - William E Smoyer
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
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17
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Donner JA, Abraham G, Bello AK, Caskey FJ, Garcia GG, Harden P, Hemmelgarn B, Johnson DW, Levin NW, Luyckx VA, Martin DE, McCulloch MI, Moosa MR, O'Connell PJ, Okpechi IG, Pecoits Filho R, Shah KD, Sola L, Swanepoel C, Tonelli M, Twahir A, van Biesen W, Varghese C, Yang CW, Zuniga C. Increasing access to integrated ESKD care as part of universal health coverage. Kidney Int 2020; 95:S1-S33. [PMID: 30904051 DOI: 10.1016/j.kint.2018.12.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India; University of Oxford, Oxford, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Georgi Abraham
- Nephrology Division, Madras Medical Mission Hospital, Pondicherry Institute of Medical Sciences, Chennai, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, JAL, Mexico
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brenda Hemmelgarn
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
| | - Nathan W Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Lecturer, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mignon I McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Charles Swanepoel
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya; Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Wim van Biesen
- Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Carlos Zuniga
- School of Medicine, Catholic University of Santisima Concepción, Concepcion, Chile
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18
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Agerskov H, Thiesson HC, Pedersen BD. The significance of relationships and dynamics in families with a child with end-stage kidney disease: A qualitative study. J Clin Nurs 2020; 29:987-995. [PMID: 31889347 DOI: 10.1111/jocn.15170] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/25/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023]
Abstract
AIM AND OBJECTIVES To explore experiences and the significance of relationships and dynamics among family members living with a child with severe kidney disease. BACKGROUND Chronic kidney disease (CKD) in children is often incurable, leading to irreversible kidney damage. End-stage kidney failure in a child impacts daily life and routines, requiring significant social adaptation for all family members. However, little is known about how individual family members experience relationships, interactions and dynamics within the family. DESIGN A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD Data were collected through semi-structured individual interviews with seven fathers, seven mothers, five children with end-stage kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading; structural analysis; and critical interpretation and discussion. The Consolidated Criteria for Reporting Qualitative Research checklist has been used (see Supporting Information). RESULTS All family members experienced relationships within and outside the family as a significant part of everyday life. The well-being of the sick child had an impact on the dynamics and emotional well-being of all family members. Siblings were in need of support; however, being fair could be challenging for parents. CONCLUSION CKD in a child has an impact on family dynamics and on the relationships between family members. Family members are vulnerable and in need of practical help and emotional support from close relatives, friends, health professionals and other individuals around them. RELEVANCE TO CLINICAL PRACTICE In clinical practice, the ability to reflect on, or interpret, a range of situations by initiating a dialogue is essential to shape both an individual perspective and the perspective of the entire family unit.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Ng DK, Matheson MB, Warady BA, Mendley SR, Furth SL, Muñoz A. Incidence of Initial Renal Replacement Therapy Over the Course of Kidney Disease in Children. Am J Epidemiol 2019; 188:2156-2164. [PMID: 31595948 PMCID: PMC7036655 DOI: 10.1093/aje/kwz220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/29/2019] [Accepted: 10/19/2019] [Indexed: 12/18/2022] Open
Abstract
The Chronic Kidney Disease in Children Study, a prospective cohort study with data collected from 2003 to 2018, provided the first opportunity to characterize the incidence of renal replacement therapy (RRT) initiation over the life course of pediatric kidney diseases. In the current analysis, parametric generalized gamma models were fitted and extrapolated for RRT overall and by specific treatment modality (dialysis or preemptive kidney transplant). Children were stratified by type of diagnosis: nonglomerular (mostly congenital; n = 650), glomerular–hemolytic uremic syndrome (HUS; n = 49), or glomerular–non-HUS (heterogeneous childhood onset; n = 216). Estimated durations of time to RRT after disease onset for 99% of the nonglomerular and glomerular–non-HUS groups were 42.5 years (95% confidence interval (CI): 31.0, 54.1) and 25.4 years (95% CI: 14.9, 36.0), respectively. Since onset for the great majority of children in the nonglomerular group was congenital, disease duration equated with age. A simulation-based estimate of age at RRT for 99% of the glomerular population was 37.9 years (95% CI: 33.6, 63.2). These models performed well in cross-validation. Children with glomerular disease received dialysis earlier and were less likely to have a preemptive kidney transplant, while the timing and proportions of dialysis and transplantation were similar for the nonglomerular group. These diagnosis-specific estimates provide insight into patient-centered prognostic information and can assist in RRT planning efforts for children with moderate-to-severe kidney disease who are receiving regular specialty care.
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Affiliation(s)
- Derek K Ng
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Matthew B Matheson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Susan R Mendley
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Susan L Furth
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alvaro Muñoz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Howell M, Walker RC, Howard K. Cost Effectiveness of Dialysis Modalities: A Systematic Review of Economic Evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:315-330. [PMID: 30714086 DOI: 10.1007/s40258-018-00455-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The economic burden of providing maintenance dialysis to those with end-stage kidney disease continues to increase. Home dialysis, including both haemodialysis and peritoneal dialysis, is commonly assumed to be more cost effective than facility dialysis, with some countries adopting a home-first policy in an attempt to reduce costs. However, the cost effectiveness of this approach is uncertain. The aim of this study is to review all published cost-effectiveness analyses comparing all alternative dialysis modalities for people with end-stage kidney disease. METHODS We conducted a systematic review of MEDLINE, the National Health Service Economic Evaluation Database, and Health Technology Assessment Database from the Centre of Reviews and Dissemination, The Cochrane Library and Econlit from January 2000 to December 2017. Published economic evaluations were included if they provided comparative information on the costs and health outcomes of alternative dialysis modalities. RESULTS The review identified 16 economic evaluations comparing dialysis modalities from both high- and low-income countries. The majority (69%) were undertaken solely from the perspective of the payer or service provider, 14 (88%) included a cost-utility analysis and eight (50%) were modelled evaluations. The studies addressed costs and health outcomes of multiple dialysis modalities, with many reporting average cost effectiveness rather than incremental cost effectiveness. Almost all evaluations suggest home dialysis to be less costly and to offer comparable or better health outcomes than in-centre haemodialysis. However, the quality-of-life benefit for each modality was poorly defined and inconsistent in terms of magnitude and direction of differences between modalities and across studies. Other issues include exclusion of competing modalities and use of arbitrary assumptions with regard to the mix of modalities. CONCLUSIONS The ability to identify the mix of dialysis modalities that provides best outcomes for patients and health budgets is uncertain particularly given the lack of societal perspectives and inconsistencies between published studies.
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Affiliation(s)
- Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Abstract
PURPOSE OF REVIEW To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally. SUMMARY Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
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Al-Doori TF, Al-Ethawi AESD, Hasan JS, Al-Kaaby BA. Towards cardiovascular risks in children with chronic kidney disease: a prospective cohort study. F1000Res 2018; 7:1794. [DOI: 10.12688/f1000research.15883.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: Children with chronic kidney disease (CKD) are at substantially high risk of morbidity and mortality from cardiovascular disease (CVD). Although this issue has been extensively studied in adults, little is known whether similar associations exist in the paediatric population. We therefore aimed to evaluate the cardiac structure and function in children with CKD, and investigate the factors that contribute to the development of CVD. Methods: A prospective cohort was established following 40 children with CKD treated in the nephrology unit at a high-volume, tertiary, teaching hospital and compared to age- and gender-matched controls of the same number. We reviewed the patients’ medical records, assessed growth parameters, measured blood pressure, took blood samples, and performed echocardiography. Results: More than half of the CKD patients are hypertensive (N = 22; 55%) and were found to have a higher proportion of increased left ventricular mass index (LVMI) (75.5%; P = 0.001). In contrast, we did not find any significant association between CKD and both valvular calcification & left ventricular (LV) fractional shortening (FS) in children (P = 0.314). Furthermore, high LVMI is found to be correlated well with the following: anaemia, hypertension, CKD duration > one year, hyperparathyroidism, estimated glomerular filtration rate (eGFR) < 15ml/minute/1.73 m2 and death (P < 0.05). Conclusions: Despite the fact that LV systolic function is preserved and valvular calcification is usually absent, left ventricular hypertrophy (LVH) is common in children with CKD. Hypertension, anaemia, hyperparathyroidism, as well as the severity and duration of renal impairment, are amongst the additional risk factors that predispose to LVH. We contribute this study to the growing information of the review articles regarding the association between CKD and CVD in paediatrics.
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