Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria

Abstract

The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria. The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome. A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes. There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million-child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow-up while another 50 (51.0%) were discharged and still on follow-up. CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.