Epidemiology and clinicopathologic outcome of pediatric chronic kidney disease in Nigeria, a single cenetr study

Abstract

Introduction: Due to dearth of data, chronic kidney disease (CKD) outcome in African children has been dismal owing to poor understanding of its etiology, manifestations and management.

Methods: We retrospectively analyzed the records of 154 CKD children and adolescents who were managed at Obafemi Awolowo University Teaching Hospitals Complex between 2000 and 2009 to evaluate the epidemiology and clinicopathologic outcome of pediatric CKD in Nigeria.

Results: Overall mean incidence was 11 (6-20) per million children population (pmcp)/year while prevalence averaged 48 (8-101) pmcp. There were 86 males (55.8%). Median age was 10.0 (0.2-15.5) years with 83.8%≥5 years old. Etiologies were glomerular disease (GMD, 90.26%), congenital and acquired urinary tract (7.79%) and hereditary disorders (1.95%). CKD stages at diagnosis were 45.5% CKD-1, 22.7% CKD-2, 10.4% CKD-3, 2.6% CKD-4 and 18.8% CKD-5. Median progression time through the CKD stages was 24.0 (3-108) months. Mean dialysis incidence and prevalence were 1 (0-4) pmcp/year and 4 (1-12) pmcp, respectively. Hypertension, heart failure (HF), malnutrition, anemia, acute-on-CKD, need for dialysis, azotemia, hypercreatininemia, and high calcium-phosphorous product (≥55 mg2/dL2) were mortality risk factors. CKD-1 survived significantly better than CKD stages 3-5 (p<0.05) but not CKD-2 (p=0.1). Hypertensive CKDs without HF survived better (73.0%) than hypertensive CKDs with HF (16.0%) [Hazard ratio (HR): 0.34, 95% CI: 0.14-0.83]. GMD survived better (68.5%) than non-GMD patients (33.0%) [HR: 2.87, 95% CI: 1.16-7.06].

Conclusion: CKD was commoner among school than pre-school age children. GMD was the predominant etiology with better outcome than non-GMD. Comorbidity prevalence increased significantly with increasing severity of CKD stage.