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The epidemiology of CKD in children in LMIC is largely unknown and underreported because of paucity of data systems in place.
A retrospective, record review of children aged 2 to 14 years with CKD stage 3 to 5 at Chris Hani Baragwanath Academic Hospital, South Africa, from 2000-2019. To assess the aetiology, risk factors, stages of CKD at diagnosis, complications and outcomes. Data was analysed using Statistica 13.5. Cox regression and Kaplan Meier survival curves were used to analyse outcomes.
A total of 198 children with CKD stage 3 to 5 were included in the analysis. The median age (IQR) at diagnosis was 7 (4 to 11) years. The median (IQR) duration of follow up was 13 (3.9 to 38.4) months. Glomerular disease accounted for 74 (37%), congenital anomalies of the kidney and urinary tract (CAKUT) for 64 (32%). Forty-one (21%) resided outside Gauteng province. The two-year survival for glomerular disease was 0.40 (40%) compared to 0.90 (90%) for CAKUT, Log rank p = 0.0001. CKD stage 5 was diagnosed in 86 (43%) children. Of the 86 children 35(41%) were treated conservatively and 51(59%) were treated with dialysis. Overall, 55 (28%) children died and 68 (34%) were lost to follow-up. Anaemia, hypoalbuminemia, proteinuria, and mineral bone disorder were significantly associated with mortality.
Children in this cohort presented in advanced kidney failure. Lack of renal centres and late referrals contributes to disease morbidity. Barriers to access renal services should be addressed.