Risk factors for childhood chronic kidney disease: a population-based study

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. [Figure not available: see fulltext.]