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
Aim & Plan Causes of CKD in children Incidence & prevalence & risks for progression Plan 1990-2000 ItalKid Project ESPN Registry, NAPRTCS 2008 Annual reports Data from Turkey
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 60-89 decrease in GFR III Moderate decrease in GFR 30-59 IV Severe decrease in GFR 15-29 V Kidney failure <15 (or dialysis) Am J Kidney Dis 2002;39:S1 266.
Year of publication Country Period Study design Definition N M/F 1995 Turkey 1979-1993 Single center GFR <50 459 1.2 1997 Sweden 1986-994 Nationwide GFR <30 118 1.6 1999 Chile 1996 Nationwide GFR <30 227 1.0 1999 India NA-1 year Single center Cre > 2 mg/dl 48 2.2 2001 Iran 1991-1999 Single center GFR <30 166 1.3 2002 Japan 1998 Nationwide ESRD 105 1.9 2003 Nigeria 1985-2000 Single center GFR <30 45 1.6
Primary renal diseases in children; Sweden 1986-1994 35 30 CRF (< 30 ml/min) TRF (RRT) 25 20 15 10 5 0 Renal Obstructive Hereditary Glomerulopathies Vascular Other hypo/dysplasia uropathies disorders nephropathies Esbjörner et al. Pediatr Nephrol 1997; 11: 438-442.
Country n Incidence Prevalence Sweden (1986-1994) 118 7.7 25.0 Chile (1996) 227 5.7 42.5 Iran (1991-1999) 166 NA NA 30 25 20 Sweden Chile Iran 15 10 5 0 Renal Obstructive Hereditary Glomerulopathies Vascular VUR Other hypo/dysplasia uropathies disorders nephropathies Esbjörner et al. Pediatr Nephrol 1997; 11: 438-442. Lagomarsimo et al. Pediatr Nephrol 1999; 13: 288-291. Madani et al. Pediatr Nephrol 2001; 16: 140-144.
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
ItalKid Project In 10 years, 1.197 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: 6.9 5.4 years The mean Ccr at registration: 41.7 20.5 ml/min/ 1.73 m 2 The mean incidence (1995 2000): 12.1 cases pmarp (8.8 13.9). The point prevalence (January 1, 2001) 74.7 cases pmarp
The incidence of RRT was 7.3/year/100 patients The risk of developing ESRD by the age of 20 years was 68%
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 (3.2-72.6)
ESPN 2008 Report 0 10 20 30 40 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
NAPRTCS 2008 (n: 7036) (1994; GFR < 75; Canada, Mexico, Costa Rica, USA) (%) 16 14 12 10 8 6 4 2 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18- Age (years) 20
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
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
NAPRTCS 2008 100% 80% 60% 18,5 Other 40% 20% 59,3 49,5 51,6 51 55,9 FSGS GN Structural 0% White Black Hispanic Other race Total
Causes of CKD 100 80 EDTA-1976 60 40 EDTA-2004 USRDS-2005 Italkid 20 BAPN 0 Unknown CAKUT Other familial SUM NAPRTCS &congenital Adapted from: Neild GH. Pediatr Nephrol 2009; 24: 1913-1919.
Etiology of chronic renal failure in Turkey Study period: 1979-1993 GFR < 50 459 children M/F: 1.23 (254/205) 0 10 20 30 40 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: 549-552.
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 2005 282 patients M/F 1.29 (159/123) mean age 8.05 ± 5.25 years
Age distribution of patients at diagnosis (%) 35 30 25 20 15 10 5 0 29 31 27,2 12,8 0-4 yrs 5-9 yrs 10-14 yrs 15-18 yrs Bek et al. Turkish SPN CKDWG. Pediatr Nephrol 2009; 24:797-806.
CKD stages of the patients at diagnosis (%) 35 30 25 20 15 10 5 0 32,5 29,8 25,8 11,9 II III IV V Bek et al. Turkish SPN CKDWG. Pediatr Nephrol 2009; 24:797-806.
Causes of CKD (%) 0 10 20 30 40 50 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; 24:797-806.
70 60 50 40 30 20 NAPRTCS Italkid Turkey 10 0 Structural GN FSGS Other
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