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. 2024 May;39(5):1509-1519.
doi: 10.1007/s00467-023-06212-5. Epub 2023 Dec 2.

Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study

Çağla Serpil Doğan  1 , Sevgin Taner  2 , Betül Durucu Tiryaki  3 , Demet Alaygut  4 , Neşe Özkayın  5 , Aslıhan Kara  6 , Aylin Gençler  7 , Ayşe Seda Pınarbaşı  8 , Hülya Nalçacıoğlu  9 , Selçuk Yüksel  10 , Okan Akacı  11 , Esra Karabağ Yılmaz  12 , Sevgi Yavuz  13 , Kenan Doğan  14 , Rumeysa Yasemin Çiçek Gülşan  15 , Gülşah Kaya Aksoy  16 , Neslihan Çiçek  17 , Bağdagül Aksu  18 , Nuran Küçük  19 , Fatma Şemsa Altugan  20 , Şenay Zırhlı Selçuk  21 , Funda Baştuğ  22 , Gökçen Erfidan  23 , Bahriye Atmış  24 , Arife Uslu Gökçeoğlu  25 , Esra Nagehan Akyol Önder  26 , Ahmet Mithat Elmacı  27 , Nurcan Cengiz  28 , Kaan Gülleroğlu  29 , Ebru Bekiroğlu Yılmaz  30 , Aslı Çelebi Tayfur  31 , Gülsün Gülay Yılmaz  32 , Sİbel Yel  33 , Cemile Pehlivanoğlu  34 , Cihangir Akgün  35 , Mehtap Akbalık Kara  3 , Beltinge Demircioğlu Kılıç  3 , Özgür Özdemir Şimşek  4 , Melike Yucal  5 , Buket Esen Ağar  6 , Metin Kaya Gürgöze  6 , İsmail Yağmur  36 , Ömer Madsar  37 , Demet Tekcan Karalı  9 , İlknur Girişgen  10 , Ece Demirci Bodur  13 , Elif Çomak  16 , İbrahim Gökçe  17 , Mehtap Kaya  19 , Yılmaz Tabel  21 , Neslihan Günay  22 , Rüveyda Gülmez  23 , Salim Çalışkan  12
Affiliations

Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study

Çağla Serpil Doğan et al. Pediatr Nephrol. 2024 May.

Abstract

Background: Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5.

Methods: Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group.

Results: A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old.

Conclusion: MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.

Keywords: Child; Chronic kidney disease; Myelomeningocele; Neurogenic bladder; Predictors.

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