Ukraine: Chronic Kidney Disease in children and adolescents: retrospective and priorities

Abstract

The present study aimed to assess the prevalence and structure of chronic kidney disease (CKD) in children and adolescents to determine the priorities for the development of pediatric nephrology in Ukraine.
 Methods. Individuals who were born in Ukraine after 1994 and had CKD diagnosed before the age of 18 were investigated. The number of CKD cases was estimated per 100,000 newborns depending on the year of birth, divided into time intervals: 1995-2004 and 2005-2022 years of birth. Both groups were stratified with the generalization of the etiological component. The patients on Kidney Replacement Therapy (KRT) were separated into special clinical group, and the etiological and age spectrum analysis of KRT initiation was performed depends of the year of birth. In addition, cross-sectional analysis of the etiological structure of KRT incidence and prevalence in years 2019 and 2021 was conducted.
 Results. The prevalence of CKD in children and adolescents in Ukraine increased over a long period up to year 2022 (average cases per 100,000 births: 43.5 in years 1995-2004, 37.0 in years 2005-2022:) with an amplification of early stages (CKD1-4: year 2010 - 81.4%, year 2022 - 92.0%) and KRT decrease, respectively (average cases per 100,000 births: 6.5 and 3.3 in the analyzed time intervals). The individuals with primary urological pathology made up a third or more among CKD patients (depending on the year of birth). The etiological and age spectrum differences of KRT were determined in the analyzed time intervals. Depending on the underlying cause of CKD, the age of KRT initiation in born before year 2005 varied from 9 to 16 years, in the following period - from 1 to 9 years.
 The differences from the ESPN Registry were identified in cross-sectional etiological spectrum of CKD with KRT initiation in year 2019 (age up to 15 years old): the higher proportion of patients after Acute Kidney Injury/AKI (16.7%) or with glomerulonephritis/GN (30.0%), and the smaller one of congenital anomalies of kidney and urinary tract/CAKUT (26.6%). The distribution of KRT causes in Ukraine under the age of 18 did not change in years 2019 and 2021 (including polycystic kidney disease/PKD 12.1-11.2%, GN 15.0-16.5%, AKI 12.1-13.1%, CAKUT 32.4-31.0%, respectively), but only for CAKUT and PKD was approximated to ISPN Global Registry data.
 Conclusions. The revealed qualitative changes in the etiological and age structure of morbidity over a long period in Ukraine indicate the CKD pathomorphosis and require updating the clinical managment of patients depends of the economic and organizational potential of the country, the challenges of martial law and the difficulties of the next recovery period.