What is the prognosis for of chronic kidney disease (CKD) in children?

Updated: Jul 21, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Answer

Once chronic kidney disease (CKD) occurs, progression to end-stage renal disease (ESRD) appears certain. In a study by Warady et al, hypoalbuminemia, hypertension, dyslipidemia, male gender, anemia, nephrotic range proteinuria, dyslipidemia at baseline, hyperphosphatemia,   and lower values for glomerular filtration rate (GFR) at baseline were predictors of rapid progression. [12]  However, the rate of progression depends on the underlying diagnosis, on the successful implementation of secondary preventive measures, and on the individual patient.

About 70% of children with chronic kidney disease develop ESRD by age 20 years. Children with ESRD have a 10-year survival rate of about 80% and an age-specific mortality rate of about 30 times that seen in children without ESRD. The most common cause of death in these children is cardiovascular disease, followed by infection. Of the deaths due to cardiovascular causes, 25% were attributed to cardiac arrest (cause uncertain), 16% to stroke, 14% to myocardial ischemia, 12% to pulmonary edema, 11% to hyperkalemia, and 22% to other cardiovascular causes, including arrhythmia. Data from the Australia and New Zealand (ANZ) registry revealed that the risk of death was associated with the year in which renal replacement therapy was initiated, the age of patients at the start of that therapy, and the type of dialysis used. [13]

Once the estimated glomerular filtration rate (eGFR) declines to less than 30 mL/min per 1.73 m2 and the child has stage IV chronic kidney disease, the child and the family should be prepared for renal replacement therapy. The family should be provided with information related to preemptive kidney transplantation, peritoneal dialysis, and hemodialysis. When preemptive transplantation is not an option, the choice between the 2 forms of dialysis is generally dictated by technical, social, and compliance issues, as well as family preference. Peritoneal dialysis is much more common in infants and younger children.

Patients on long-term dialysis have a high incidence of morbidity and mortality. Preemptive renal transplantation should be the goal of management in these children.


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