Epidemiology of CKD in Children

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1 Epidemiology of CKD in Children Ali Düzova, M.D. Hacettepe University Faculty of Medicine Pediatric Nephrology and Rheumatology Unit Ankara CKD Course 03 June 2011, İstanbul

2 Aim & Plan Causes of CKD in children Incidence & prevalence & risks for progression Plan ItalKid Project ESPN Registry, NAPRTCS 2008 Annual reports Data from Turkey

3 K/DOQI stages of CKD Stage Description GFR (ml/min/1.73 m 2 ) I Kidney damage with normal or 90 increased GFR II Kidney damage with mild decrease in GFR III Moderate decrease in GFR IV Severe decrease in GFR V Kidney failure <15 (or dialysis) Am J Kidney Dis 2002;39:S1 266.

4 Year of publication Country Period Study design Definition N M/F 1995 Turkey Single center GFR < Sweden Nationwide GFR < Chile 1996 Nationwide GFR < India NA-1 year Single center Cre > 2 mg/dl Iran Single center GFR < Japan 1998 Nationwide ESRD Nigeria Single center GFR <

5 Primary renal diseases in children; Sweden CRF (< 30 ml/min) TRF (RRT) Renal Obstructive Hereditary Glomerulopathies Vascular Other hypo/dysplasia uropathies disorders nephropathies Esbjörner et al. Pediatr Nephrol 1997; 11:

6 Country n Incidence Prevalence Sweden ( ) Chile (1996) Iran ( ) 166 NA NA Sweden Chile Iran Renal Obstructive Hereditary Glomerulopathies Vascular VUR Other hypo/dysplasia uropathies disorders nephropathies Esbjörner et al. Pediatr Nephrol 1997; 11: Lagomarsimo et al. Pediatr Nephrol 1999; 13: Madani et al. Pediatr Nephrol 2001; 16:

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8 ItalKid Project Population based registry in 1990 Covered the entire country, 16.8 million children Inclusion criteria Creatinine clearance of 75 ml/min/1.73 m 2 for children < 1 year: Serum Cre > mean scr + 3 SD; Age younger than 20 years at the time of registration

9 ItalKid Project In 10 years, pts. have been registered. M/F: 2.03 for the population as a whole 1.72 when the pts. with PUV were excluded. The mean age at registration: years The mean Ccr at registration: ml/min/ 1.73 m 2 The mean incidence ( ): 12.1 cases pmarp ( ). The point prevalence (January 1, 2001) 74.7 cases pmarp

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11 The incidence of RRT was 7.3/year/100 patients The risk of developing ESRD by the age of 20 years was 68%

12 ESPN 2008 Report Total population: 628 million Children (0-14 years): 98 million (15.6%) Patients accepted for RRT Incidence 5.2 pmarp (0-24.5) Prevalence 28.6 pmarp ( )

13 ESPN 2008 Report Glomerulonephritis CAKUT Cystic KD Hereditary Ishemic HUS Metabolic Vasculitis Pyelonephritis Miscellaneous 7,2 2,2 5,8 3,4 2,8 1,2 7 7,4 11,8 15,2 35,3 Unknown

14 NAPRTCS 2008 (n: 7036) (1994; GFR < 75; Canada, Mexico, Costa Rica, USA) (%) Age (years) 20

15 NAPRTCS 2008 Structural Prune belly, reflux nephropathy and aplasia/hypoplasia/displasias Glomerulonephritis Chronic GN, idiopathic crescentic GN MPGN, MGN, SLE, HSP, IgAN Wegener s granulomatosis FSGS Other

16 NAPRTCS 2008 (n: 7026) 100% 80% 60% 40% 20% 73 64,2 58,2 16,2 16,5 38,7 55,9 Other FSGS GN Structural 0% 0-1 year 2-5 years 6-12 years > 12 years Total

17 NAPRTCS % 80% 60% 18,5 Other 40% 20% 59,3 49,5 51, ,9 FSGS GN Structural 0% White Black Hispanic Other race Total

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23 Causes of CKD EDTA EDTA-2004 USRDS-2005 Italkid 20 BAPN 0 Unknown CAKUT Other familial SUM NAPRTCS &congenital Adapted from: Neild GH. Pediatr Nephrol 2009; 24:

24 Etiology of chronic renal failure in Turkey Study period: GFR < children M/F: 1.23 (254/205) Reflux nephropathy Glomerular diseases Hereditary Amyloidosis Urinary stones Other 8 11,4 10,6 15,4 22,2 32,4 Sirin A et al. Pediatr Nephrol 1995; 9:

25 Turkish Society for Pediatric Nephrology-CKD Working Group 29 pediatric nephrology centers in Turkey egfr 75 ml/min per 1.73 m 2 < 19 years, diagnosed in patients M/F 1.29 (159/123) mean age 8.05 ± 5.25 years

26 Age distribution of patients at diagnosis (%) ,2 12,8 0-4 yrs 5-9 yrs yrs yrs Bek et al. Turkish SPN CKDWG. Pediatr Nephrol 2009; 24:

27 CKD stages of the patients at diagnosis (%) ,5 29,8 25,8 11,9 II III IV V Bek et al. Turkish SPN CKDWG. Pediatr Nephrol 2009; 24:

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29 Causes of CKD (%) Urological problems Hypoplasia; dysplasia, aplasia Cystic d. Hereditary metabolic Primary GN Sec. GN 4,9 4,6 7 12,6 11,4 44,3 Bek et al. Turkish SPN CKDWG. Pediatr Nephrol 2009; 24:

30 NAPRTCS Italkid Turkey 10 0 Structural GN FSGS Other

31 Summary Leading causes: CAKUT, Other congenital and familial diseases. Factors affecting the pattern Race, ethnicity, environment, wealth, age, time Preventable, curable in certain cases Measures to slow down progression

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