A Descriptive Study of Chronic Kidney Disease (Stages 3–5) in Children at Chris Hani Baragwanath Academic Hospital, 2000–2019

Abstract

Background The epidemiology and outcome of chronic kidney disease (CKD) in children of less resourced countries are largely underreported because of paucity of data systems. Methods A retrospective follow-up study of children aged 2 to 14 years with CKD stage 3 to 5 at Chris Hani Baragwanath Academic Hospital (CHBAH), South Africa, from 2000-2019. Results A total of 198 children were analysed. Sixty-five (32.8%), 47 (23.7%), and 86 (43.4%) had CKD stages 3, 4 and 5 at diagnosis, respectively. The median (inter quartile range (IQR)) age at diagnosis was 7 (4-11) years and duration of follow up was 1.2 (0.3-3.2) years. The calculated annual incidence in 2001 to 2019 ranged from 9.3 to 29.7 per million age related population (PMARP). Glomerular disease accounted for 74 (37%); congenital anomalies of the kidney and urinary tract (CAKUT) for 64 (32%). At final outcome, 108 children had CKD stage 5. Seventy-three (67.5%) received kidney replacement therapy (KRT) and 35 (32.4%) treated conservatively. The mean rate of decline in eGFR from baseline to final visit was 4.90 (SD 7.03) ml/min/BSA per year. The mortality rate was 9.8 (95%CI:7.3 to 13.1) person-years (PY), contributed by 46 (23.3%) children. The two-year survival for glomerular disease was 50% compared to 90% for CAKUT. Risk of mortality increased in CKD stage 5 (AHR=3.5; 95%CI:1.5-7.9, p-value 0.002), hypoalbuminemia (AHR=2.6; 95%CI:1.0-6.2, p-value 0.030) and glomerular disease (AHR=2.5;95%CI:1.0-6.3, p-value 0.046). Conclusion This cohort presented in advanced CKD. Barriers to access renal services should be addressed to achieve sustainable developmental goals (SDG).