Chronic kidney disease in children in Ukraine

Abstract

The study aimed to summarize data of Chronic Kidney Disease (CKD) in children and adolescents in Ukraine. Methods. There were performed a qualitative study based on published documents and registers, and a cohort observational study included 3528 depersonalized patients with CKD diagnosed before the age of 18. That was used cross-sectional and longitudinal design for the structure, etiology, and outcomes analysis, period comparison (years 2014 and 2019), quantitative analyzes depending on patients age and nosology, risk measurements and survival function. Results. There was found the tendency to reduce the incidence of the genitourinary system diseases in childhood, and the predominance of these classes of diseases in adolescents. The main causes of CKD were congenital structural or histological abnormalities and glomerulonephritis. Prolonged kidney function preservation at the initial level was confirmed in many patients (CKD1 was maintained in 33.0% and CKD5 - in 56.6% causes after 5 years period) with the partial function improvement in CKD1-3. CKD1-4 probability at the 1st year of observation was 91.7±0.47%, at the 5th year - 84.2±0.82%. The structural CKD5 specialties in patients receiving Kidney Replacement Therapy have been established. There was a significantly higher risk of CKD5 during 5 years period after Acute Kidney Injury (OR 2.81-2.10), and a lower probability of CKD5 in patients with glomerulonephritis (OR 0.66-0.54) compared to other nosology. CKD pathomorphosis was found in the year 2019 compared to the year 2014: the kidney dysplasia as an etiological factor was increased (from 19.3% to 22.0%, р=0.040); the immediate outcome at the 1st year of observation was improved with the lower risk of declaring of Glomerular Filtration Rate (GFR) to CKD5 level (93.6% vs. 90.0%), but the late follow-up prognosis became worse (the cumulative probability of CKD1-4 at the 5th year of observation decreased from 85.5 to 73.9%, p=0.016); the structure of Kidney Replacement Therapy changed with the increasing part of transplanted patients (from 30.5% to 48.9%, p<0.001), especially as a first choice (pre-dialysis); the tendency to decrease the proportion of polycystic kidney disease in CKD and to increase it in CKD5 was revealed with risk raising of GFR loss <15 ml/min in the year 2019 compared to other nosology (OR 1.69, p=0.027). Conclusions. The established epidemiological and clinical realities are important for determining the kidney disease outcome in children and adolescents, assessing the medical management of these patients, sharpening the priorities of pediatric nephrology, and emphasizing the significance of further studies with appropriate regulations.