Epidemiology of chronic kidney disease in children in Serbia
Amira Peco-Antic
1
2
3
Radovan Bogdanovic
0
2
3
Dusan Paripovic
1
2
Aleksandra Paripovic
0
2
Nikola Kocev
2
3
Emilija Golubovic
2
6
7
Biljana Milosevic
2
4
5
on behalf of the Serbian Pediatric Registry of Chronic Kidney Disease (SPRECKID)
2
0
Department of Nephrology, Institute of Mother and Child Health care
, Belgrade,
Serbia
1
Department of Nephrology, University Children's Hospital
, Belgrade,
Serbia
2
Methods. Since 2000-09, data on incidence, prevalence, aetiology, treatment modalities and outcome of children aged 0-18 years, with CKD Stages 2-4 and CKD Stage 5,
were collected by reporting index cases from paediatric centres
3
Faculty of Medicine, University of Belgrade
, Belgrade,
Serbia
4
Department of Nephrology, Institute of Children and Youth Health care
, Novi Sad,
Serbia
5
Faculty of Medicine, University of Novi Sad
, Novi Sad,
Serbia
6
Department of Nephrology, Clinic of Children's Internal Disease, Clinical Center of Nis
, Nis,
Serbia
7
Faculty of Medicine, University of Nis
, Nis,
Serbia
Background. The epidemiological information from welldefined populations regarding childhood chronic kidney disease (CKD), particularly those concerning non-terminal stages, are scanty. The epidemiology of CKD in children is often based on renal replacement therapy (RRT) data, which means that a considerable number of children in earlier stages of CKD are missed as they will reach end-stage renal disease (ESRD) in adulthood. Here, we report the basic epidemiological data on childhood CKD in Serbia, gathered over the 10-year period of activity of the Serbian Pediatric Registry of Chronic Kidney Disease.
-
Results. Three hundred and thirty-six children were
registered (211 boys, 125 girls, male/female ratio 1.7). The
median age at registration was 9.0 years [interquartile range
(IQR) 313]. Median follow-up was 4.0 years (IQR, 19).
The median glomerular filtration rate (GFR) at the time of the
registration was 39.6 mL/min/1.73m2 (IQR, 13.865.4).
Median annual incidence of CKD 25 stages was 14.3 per
million age-related population (p.m.a.r.p.), while those of CKD
24 or CKD 5 were 9.1 and 5.7 p.m.a.r.p., respectively. The
median prevalence of CKD 25 was 96.1 p.m.a.r.p., 52.8
p.m.a.r.p. in CKD 24 and 62.2 p.m.a.r.p. in CKD 5. The
main causes of CKD were congenital anomalies of kidney
and urinary tract and hereditary nephropathies. Kidney
survival was the worst in children with glomerular
diseases and in those with advanced CKD. Haemodialysis
was the most common first modality of RRT. Mortality
rate was 4.5%, mainly due to cardiovascular and
infectious complications.
Conclusions. Epidemiology of paediatric CKD in Serbia is
similar to that reported from developed European countries.
The knowledge of the epidemiology of earlier stages of CKD
is essential for both institution of renoprotective therapy and
planning of RRT, a fact of paramount importance in countries
with limited resources.
Introduction
The epidemiological reports on non-terminal stages of
paediatric chronic kidney disease (CKD) from well-defined
populations are rare [15]. The existing epidemiological data on
CKD in children mainly focus on renal replacement therapy
(RRT) [611], which represent only part of the population
suffering from CKD during childhood, as a considerable
number of children with renal impairment will reach
endstage renal disease (ESRD) in adulthood. Knowledge of the
epidemiology of earlier stages of CKD is crucial for early
detection, primary prevention and for the assessment of the
impact of renoprotective therapy. Furthermore, a
populationbased paediatric CKD registry is necessary for planning of
RRT, which is highly dependent upon economy and
availability of health care resources. This aspect is very important
for developing countries with limited financial capacities,
such as Serbia. Therefore, in 2000, the Serbian Pediatric
Nephrology Working Group established the Serbian Pediatric
Registry of Chronic Kidney Disease (SPRECKID). Here, we
report the basic epidemiological data resulting from the first
10 years of SPRECKID activity.
Materials and methods
The index cases were defined using the following criteria: (i) decreased
glomerular filtration rate (GFR) for at least 3 months <90 mL/min/1.73m2
for children >2 years and for younger ones, serum creatinine persistently
above mean 1 2D [12]; (ii) age <19 years at the time of registration and
(iii) written informed consent for data collection, reporting and storage.
All the Serbian centres potentially involved in caring of children and
adolescents with CKD were invited to report index cases. The Unit of
Pediatric Nephrology of University Childrens Hospital in Belgrade acted
as the national coordinating centre that developed the study standards,
processed the data and coordinated with regional principal investigators.
The data collection was structured into the SPRECKID core data set
including date of birth, gender, cause of renal disease, referral region, body height
and bo (...truncated)