Chronic Kidney Disease In Children Research Articles

РАННЯЯ ДИАГНОСТИКА ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У ДЕТЕЙ С ПОМОЩЬЮ АЛГОРИТМОВ МАШИННОГО ОБУЧЕНИЯ

Background. Diagnosis of early-stage chronic kidney disease (CKD) is a global challenge, as late-stage disease is more commonly diagnosed. The development of modeling methods for making management decisions aimed at improving the efficiency of early diagnosis of CKD is an important scientific and practical task, which can be greatly supported by the use of machine learning algorithms (MLA). Aim. To improve the accuracy of diagnosis of CKD using data from history, clinical-instrumental, genetic examination and machine learning algorithms (MLA). Methods. Data were obtained from a single-center retrospective catamnestic cohort study (2011–2022) of children with CKD stage 1–4 aged 1 to 17 years. The main group included 128 children with CKD, and the comparison group included 30 children without any kidney disease. Two groups were comparable by sex and age. The data of anamnesis, clinical-instrumental and genetic examination were used to build a model for CKD diagnosis. The model was built using the MLA multivariate logistic regression (MLR). Three variables were used in the model: erythrocyte sedimentation rate in blood (β = 0,392; p<0,001); erythrocytes in urine (β = 1,225; p<0,001); and asthenic physique (β = 5,792; p<0,001). Results. A diagnostics model was obtained allowing prediction of CKD on a test sample with accuracy of 90,3% [80,6; 96,8], sensitivity of 92,0% [81,5; 100,0], specificity of 83,3% [50,0; 100,0], ROC-AUC = 90,0% [77,2; 100,0]. The resulting model is of excellent quality (>90%) as the ROC-AUC is 0,90 on the test sample. The cut-off point value of the probability of CKD is 0,25. Conclusions. We developed and tested the model that diagnoses early-stage CKD in children with high accuracy

To Evaluate the Epidemiology, Etiology, Risk Factors and Treatment Management in Chronic Kidney Disease in Children, Adult and Geriatric Patients in a Tertiary Care Teaching Hospital in Nellore

Chronic renal failure is a life-threatening disease to society. The study was conducted from October 2021 to June 2023 the study was done in the Nephrology inpatient ward, Vijaya Super Speciality Hospital, Pogathota Nellore, Andhra Pradesh. The study design is a cross-sectional for epidemiology and prospective observational study-1 for etiology, II-risk factors, III-treatment management. The sample size are 381 subjects in that children are 51 subjects, adult 171 subjects and geriatric are 159 subjects. The male are 199 volunteers and the female are 182 volunteers with chronic kidney disease (CKD). The result of this study was the epidemiology factor more in adults (45%) when compared to children (13%) and geriatrics (42%). In the sex parameters are less affected to females (48%) and males (52%) are more affected with chronic kidney disease. The etiology causes in children are glomerulonephritis, adults diabetes mellitus (DM) and geriatrics pyelonephritis these are the main causes for chronic renal disease when compared to other etiological causes. Risk factors in children are congenital defects, adult are diabetes mellitus and geriatric are kidney disease these are the risk factors to the renal failure patients. In treatment management, hemodialysis is the most effective treatment to adults when compared to children’s and geriatric eng stage renal failure disease. The conclusion of this study initially may rectify causes and risk factors of the patients may not high prevalent in end-stage renal failure disease it not cause hemodialysis therapy and renal transplantation in children, adults and geriatric patients.

Global, regional and national burden of CKD in children and adolescents from 1990 to 2019.

Chronic kidney disease(CKD) is one of the most prevalent non-communicable health concerns in children and adolescents worldwide; however, data on its incidence, prevalence, disability-adjusted life years (DALYs) and trends in the population are limited. We aimed to assess the global, regional and national trends in CKD burden in children and adolescents. In this trend analysis based on the 2019 Global Diseases, Injuries, and Risk Factors Study, CKD incidence, prevalence and DALYs rates per 100000 population for children and adolescents were reported at the global, regional and national levels, as well as the average annual percentage change (AAPC). These global trends were analyzed by age, sex, region and socio-demographic index (SDI). Globally, the overall incidence of CKD (all stages including kidney replacement therapy) in children and adolescents showed an increasing trend [AAPC 0.44 (95% confidence interval 0.36-0.52)] between 1990 and 2019. Similarly, the overall prevalence of CKD also showed an upward trend [AAPC 0.46 (0.42-0.51)]. However, the DALYs of CKD showed a continuous decreasing trend [AAPC -1.18 (-1.37 to -0.99)]. The population aged 15-19 years had the largest CKD incidence increase during this period. The largest increase in age-standardized incidence rate (ASIR) was in middle SDI countries [AAPC 0.56 (0.45-0.67)]. The relationship between the ASIR and SDI showed an inverse U-shaped correlation while the relationship between the age-standardized DALYs rate (ASDR) and SDI showed an inverse trend with SDI. Among adolescents (15-19 years), the ASIR continued to increase for five causes of CKD, owing to type 2 diabetes mellitus and hypertension. Most of the disease burden was concentrated in countries with a lower SDI. Andean Latin America and Central Latin America showed the largest increases in CKD ASIR between 1990 and 2019. The burden of CKD in children and adolescents has increased worldwide, especially in regions and countries with a lower SDI.

Plasma and Urinary Platelet Factor 4 as Biomarkers for Cardiovascular Risk in Children with Chronic Kidney Disease.

Children suffering from chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). The early detection and diagnosis of subclinical CVD in pediatric CKD can reduce mortality later in life. Plasma factor 4 (PF4) is a chemokine released by activated platelets. We examined whether or not PF4 in the plasma and urine, its kidney function normalized ratio, and fractional excretion have differential associations with CVD risk markers in 139 youths aged 3 to 18 years old with CKD stages G1-G4. Significant negative correlations were observed between plasma PF4 and cardiovascular surrogate markers, such as the left ventricular mass index (LVMI), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV). The plasma PF4/creatinine (Cr) ratio was lower in CKD children with a high daytime BP and 24 h BP, high BP load, and nocturnal non-dipping status. After adjusting for confounders, the plasma PF4 and plasma PF4/Cr ratio still independently predicted an abnormal ABPM profile. In addition, both the plasma PF4 and plasma PF4/Cr ratio presented a negative correlation with the L-arginine and asymmetric dimethylarginine ratio. These findings provide convincing evidence supporting the link between PF4 and CVD markers in pediatric CKD. Our study highlights the importance of further research to assess the performance of PF4-related biomarkers in predicting CVD events and CKD progression in children with CKD.

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

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. Data from children aged 0-19years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1year of age without pre-existing kidneyabnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group. 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 13years old (range 2-18years). 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 15years old. 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.

Plasma Metabolomics of Dietary Intake of Protein-Rich Foods and Kidney Disease Progression in Children

Evidence regarding the efficacy of a low-protein diet for patients with CKD is inconsistent and recommending a low-protein diet for pediatric patients is controversial. There is also a lack of objective biomarkers of dietary intake. The purpose of this study was to identify plasma metabolites associated with dietary intake of protein and to assess whether protein-related metabolites are associated with CKD progression. Nontargeted metabolomics was conducted in plasma samples from 484 Chronic Kidney Disease in Children (CKiD) participants. Multivariable linear regression estimated the cross-sectional association between 949 known, nondrug metabolites and dietary intake of total protein, animal protein, plant protein, chicken, dairy, nuts and beans, red and processed meat, fish, and eggs, adjusting for demographic, clinical, and dietary covariates. Cox proportional hazards models assessed the prospective association between protein-related metabolites and CKD progression defined as the initiation of kidney replacement therapy or 50% eGFR reduction, adjusting for demographic and clinical covariates. One hundred and twenty-seven (26%) children experienced CKD progression during 5years of follow-up. Sixty metabolites were significantly associated with dietary protein intake. Among the 60 metabolites, 10 metabolites were significantly associated with CKD progression (animal protein: n=1, dairy: n=7, red and processed meat: n=2, nuts and beans: n=1), including one amino acid, one cofactor and vitamin, 4 lipids, 2 nucleotides, one peptide, and one xenobiotic. 1-(1-enyl-palmitoyl)-2-oleoyl-glycerophosphoethanolamine (GPE, P-16:0/18:1) was positively associated with dietary intake of red and processed meat, and a doubling of its abundance was associated with 88% higher risk of CKD progression. 3-ureidopropionate was inversely associated with dietary intake of red and processed meat, and a doubling of its abundance was associated with 48% lower risk of CKD progression. Untargeted plasma metabolomic profiling revealed metabolites associated with dietary intake of protein and CKD progression in a pediatric population.

Systemic Immune Inflammation Index as a Key Predictor of Dialysis in Pediatric Chronic Kidney Disease with the Use of Random Forest Classifier.

Low-grade inflammation is a significant component of chronic kidney disease (CKD). Systemic immune inflammation index (SII), a newly defined ratio combining neutrophil, lymphocyte, and platelet counts, has not yet been evaluated in the pediatric CKD population nor in the context of CKD progression or dialysis. Thus, this study aimed to analyze the complete blood cell count (CBC)-driven parameters, including SII, in children with CKD and to assess their potential usefulness in the prediction of the need for chronic dialysis. A single-center, retrospective study was conducted on 27 predialysis children with CKD stages 4-5 and 39 children on chronic dialysis. The data were analyzed with the artificial intelligence tools. The Random Forest Classifier (RFC) model with the input variables of neutrophil count, mean platelet volume (MPV), and SII turned out to be the best predictor of the progression of pediatric CKD into end-stage kidney disease (ESKD) requiring dialysis. Out of these variables, SII showed the largest share in the prediction of the need for renal replacement therapy. Chronic inflammation plays a pivotal role in the progression of CKD into ESKD. Among CBC-driven ratios, SII seems to be the most useful predictor of the need for chronic dialysis in CKD children.

Food Insecurity Is Associated with Short Stature, Slow Growth Velocity, and Lower Cognitive Function in the Chronic Kidney Disease in Children (CKiD) Cohort

Food Insecurity Is Associated with Short Stature, Slow Growth Velocity, and Lower Cognitive Function in the Chronic Kidney Disease in Children (CKiD) Cohort

ASSESSMENT OF THE QUALITY OF LIFE OF CHILDREN WITH CHRONIC KIDNEY DISEASE IS IMPORTANT INFORMATION IN PROVIDING SERVICES: SYSTEMATIC REVIEW

ABSTRACT Background: Children with chronic kidney disease (CKD) continue to face significant health challenges, with a growing morbidity rate that lowers their quality of life (QoL). Children with CKD experience complex problems physically, emotionally, socially and at school, requiring different problem solving for each child. At the assessment stage, assessing the quality of life is very important, the results of which determine the next steps regarding the child's care and treatment. Purpose: The aim of this research is to determine the best service delivery based on assessing the quality of life of CKD children based on research results. Methods: Systematic review study was for children determine the best service delivery based on assessing the QoL with CKD. Electronic database and reference list of relevant articles from 2016 to 2023. Guided by PRISMA guidelines, five electronic database PubMed, EBSCO, PROQUEST, Science Direct, and Google Scholar-were searched for relevant articles published in Indonesia and English. Results: From 11 studies, it was found that the majority of children with CKD had a low quality of life in terms of physical, emotional, social and academic function, even though the quality of life of children who underwent a renal transplant (RT) was better than children who underwent a RT, undergoing hemodialysis (HD) and peritoneal dialysis (PD), to improve the QoL proper care is needed, one of which is camping activities by camping, children assess their quality of life positively, with self-esteem as the most felt dimension. Short stature, low family income, use of dialysis, and depression are risk factors associated with lower overall QoL. Conclusion: Research reveals that almost all children with CKD score poorly on QoL assessments. Children with CKD experience a poor quality of life, and require team and comprehensive work to improve the child's quality of life. Quality of life assessment is a reflection of the need for appropriate care and treatment for the child and family. Keywords: Quality of life, Children, Chronic kidney disease

Association of Ischemia-Modified Albumin (IMA) in Saliva, Serum, and Urine with Diagnosis of Chronic Kidney Disease (CKD) in Children: A Case-Control Study.

BACKGROUND Ischemia-modified albumin (IMA) is a secreted biomarker for ischemic oxidative stress. This case-control study aimed to evaluate the association of ischemia-modified albumin (IMA) in saliva, serum, and urine with diagnosis of chronic kidney disease (CKD) in 24 children. MATERIAL AND METHODS The study involved 24 children with CKD. CKD was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. The control group consisted of 24 healthy children who were matched for age and gender to the experimental group. The concentration of IMA was determined by the colorimetric method in non-stimulated whole saliva (NWS), stimulated whole saliva (SWS), serum, and urine of children with CKD. The Mann-Whitney U test was used for inter-group comparisons. RESULTS IMA levels were significantly higher in NWS (P=0.0082) and SWS (P=0.0014) of children with CKD than in the control group. The concentration of IMA in NWS was correlated with standard indicators of kidney function, including the estimated glomerular filtration rate (r=-0.798, P≤0.0001), stage of CKD (r=0.814, P≤0.0001), and serum creatinine (r=0.711, P≤0.0001) and urea levels (r=0.738, P≤0.0001). CONCLUSIONS Salivary IMA concentration depends on renal function in children. Salivary IMA discriminates children with end-stage kidney disease from children with mild and moderate CKD and healthy children with high sensitivity and specificity. Further research is required, including assessment of the diagnostic usefulness and validation of the biomarker in a clinical diagnostic study.

Circulating Metabolomic Associations with Neurocognitive Outcomes in Pediatric CKD.

Children with CKD are at risk for impaired neurocognitive functioning. We investigated metabolomic associations with neurocognition in children with CKD. We leveraged data from the Chronic Kidney Disease in Children (CKiD) study and the Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) study. CKiD is a multi-institutional cohort that enrolled children aged 6 months to 16 years with eGFR 30-90 ml/min per 1.73 m 2 ( n =569). NiCK is a single-center cross-sectional study of participants aged 8-25 years with eGFR<90 ml/min per 1.73 m 2 ( n =60) and matched healthy controls ( n =67). Untargeted metabolomic quantification was performed on plasma (CKiD, 622 metabolites) and serum (NiCK, 825 metabolites) samples. Four neurocognitive domains were assessed: intelligence, attention regulation, working memory, and parent ratings of executive function. Repeat assessments were performed in CKiD at 2-year intervals. Linear regression and linear mixed-effects regression analyses adjusting for age, sex, delivery history, hypertension, proteinuria, CKD duration, and glomerular versus nonglomerular diagnosis were used to identify metabolites associated with neurocognitive z-scores. Analyses were performed with and without adjustment for eGFR. There were multiple metabolite associations with neurocognition observed in at least two of the analytic samples (CKiD baseline, CKiD follow-up, and NiCK CKD). Most of these metabolites were significantly elevated in children with CKD compared with healthy controls in NiCK. Notable signals included associations with parental ratings of executive function: phenylacetylglutamine, indoleacetylglutamine, and trimethylamine N-oxide-and with intelligence: γ -glutamyl amino acids and aconitate. Several metabolites were associated with neurocognitive dysfunction in pediatric CKD, implicating gut microbiome-derived substances, mitochondrial dysfunction, and altered energy metabolism, circulating toxins, and redox homeostasis. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_17_CJN0000000000000318.mp3.

Predicting pediatric kidney disease progression—are 3 variables all you need?

Accurate estimation of chronic kidney disease (CKD) progression risk is vital for clinical decision-making. Existing risk equations lack validation in pediatric CKD populations. Ng etal. developed new risk equations using the CKD in Children and European Study Consortium for Chronic Kidney Disorders Affecting Pediatric Patients cohorts. The elementary model, incorporating estimated glomerular filtration rate, urine protein-creatinine ratio, and diagnosis, exhibited excellent discrimination and calibration at external validation. External validation of enriched models is pending. The equations have the potential to aid pediatric CKD centers in patient counseling and care planning.

A-322 Implementation of Three Age- and Sex-Dependent Equations to Estimate Glomerular Filtration Rates (eGFR) at a Pediatric Institution

Abstract Background The National Kidney Foundation estimates that 37 million people in the United States are affected by kidney disease, although 90% of them are unaware of it. While kidney disease is less common in children and adolescents, early diagnosis and treatment is important due to the significant long-term impact it can have on growth, cognitive development, and cardiovascular disease. Unlike adults, the estimated glomerular filtration rate (eGFR) for pediatric patients is not routinely reported by clinical laboratories. The process of estimating GFR is cumbersome and time-consuming for clinicians, requiring data extraction to use estimating equations with variable accuracy. The Chronic Kidney Disease in Children (CKiD) Study has developed and published new, more precise, estimating equations for use in children and young adults that utilize a sex- and age-dependent constant (k) in conjunction with height and serum creatinine and/or serum cystatin-C. In collaboration with Nephrology and Laboratory Information Technology, we implemented three eGFR equations into our laboratory information system (LIS) and currently report the results in the patient's electronic medical record (EMR). Methods The three equations that were implemented were named eGFR-creatinine (eGFR = k x (height/sCr) with height in m and serum creatinine in mg/dL), eGFR-cystatin (eGFR = k×(1/cysC) with serum cystatin-C in mg/L), and eGFR-average, which reports the average of the creatinine and cystatin-C estimating equations when both are ordered. The k constant is dependent on the patient's age and sex. An eGFR value of &amp;gt;90 mL/min|1.73m2 is considered normal. When an eGFR is ordered, the system identifies the most recent creatinine or cystatin-C result. If one has not been resulted in the last 2 hours, the system reflexes an order for a basic metabolic panel or a cystatin-C. For the eGFR-creatinine equation, the system looks back up to 3 months for a height and uses the most current value. Concordance and discordance were determined in patients who had all three equations ordered and compared as to whether all three values gave a result above or below 90 mL/min|1.73 m2. Results The eGFR-creatinine equation went live in June 2022. As of January 2023, 287 eGFR-creatinine values have been resulted. The cystatin-C assay, eGFR-cystatin equation, and e-GFR average equations went live in November 2022. As of January 2023, 114 eGFR-averages and 167 eGFR-cystatins have been resulted. When both equations were ordered and the eGFR-average was calculated, all three values were concordant 69 times (61%) and discordant 45 times (39%). In 26 instances, the eGFR-creatine value was discrepant compared with the other two equations and in 19 instances, the eGFR-cystatin value was discrepant. The differences between the eGFR equations ranged from 1.1–41.9%, however 65% of the values varied by less than 10% and 88% varied by less than 20%. Conclusion Implementation of pediatric eGFR equations into the LIS and reporting of eGFR in the EMR will allow more accurate assessment of pediatric patients’ kidney function and improved clinician and patient awareness of impaired kidney function. Availability of this information will allow an earlier diagnosis and treatment of chronic kidney disease.

Associations between anemia and FGF23 in the CKiD study

BackgroundFibroblast growth factor 23 (FGF23) is a bone-derived hormone that plays a central role in chronic kidney disease-mineral bone disorder and is associated with CKD progression and cardiovascular morbidity. Factors related to CKD-associated anemia, including iron deficiency, can increase FGF23 production. This study aimed to assess whether anemia and/or iron deficiency are associated with increased circulating concentrations of FGF23 in the large, well-characterized Chronic Kidney Disease in Children (CKiD) study cohort.MethodsHemoglobin concentrations, iron parameters, C-terminal (total) FGF23, intact FGF23, and relevant covariables were measured in cross-sectional analysis of CKiD study subjects.ResultsIn 493 pediatric patients with CKD (median [interquartile range] age 13 [9, 16] years), the median estimated glomerular filtration rate was 48 [35, 61] ml/min/1.73 m2, and 103 patients (21%) were anemic. Anemic subjects had higher total FGF23 concentrations than non-anemic subjects (204 [124, 390] vs. 109 [77, 168] RU/ml, p < 0.001). In multivariable linear regression modeling, anemia was independently associated with higher total FGF23, after adjustment for demographic, kidney-related, mineral metabolism, and inflammatory covariables (standardized β (95% confidence interval) 0.10 (0.04, 0.17), p = 0.002). In the subset of subjects with available iron parameters (n = 191), iron deficiency was not associated with significantly higher total FGF23 concentrations. In the subgroup that had measurements of both total and intact FGF23 (n = 185), in fully adjusted models, anemia was significantly associated with higher total FGF23 (standardized β (95% CI) 0.16 (0.04, 0.27), p = 0.008) but not intact FGF23 (standardized β (95% CI) 0.02 (−0.12, 0.15), p = 0.81).ConclusionsIn this cohort of pediatric patients with CKD, anemia was associated with increased total FGF23 levels but was not independently associated with elevated intact FGF23, suggesting possible effects on both FGF23 production and cleavage. Further studies are warranted to investigate non-mineral factors affecting FGF23 production and metabolism in CKD.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Clinical significance of kidney immune complex deposition in children with acute interstitial nephritis disease

Background Acute interstitial nephritis (AIN) is a relatively rare cause of acute kidney injury (AKI) in children. Immune complex (IC) deposition was rare in renal pathology of AIN. Methods Based on the status and position of IC deposition, a total of 78 children with AIN were divided into two groups: the non-IC group and IC group. IC group was further divided into two subgroups: intraglomerular (IG)-IC group and extraglomerular (EG)-IC group. To compare the clinical and histological features, renal outcomes between groups. Results The IC deposition, IG-IC and EG-IC deposition were observed in 22 (28.21%), 12 (15.38%) and 10 (12.82%) children, respectively. The IC group demonstrated a higher frequency of AKI, higher level of Scr, urine N-acetyl-β-D-glucosidase (NAG) enzyme, retinol-binding protein (RBP), neutrophil gelatinase-associated lipocalin (NGAL), higher frequency of neutrophils, plasma cells and eosinophils infiltrate, higher scores of interstitial inflammation (i), total inflammation (ti) and interstitial edema, lower level of estimated glomerular filtration rate (eGFR) as compared to non-IC group (p < 0.05, p < 0.01). EG-IC deposition positively moderate correlated with levels of RBP, IG-IC deposition positively moderate correlated with plasma cell infiltrate, interstitial inflammation (i), total inflammation (ti) and interstitial edema. Interstitial inflammation, EG-IC deposition and interstitial edema were risk factors for AKD in AIN, and interstitial fibrosis/tubular atrophy (IF/TA) was a risk factor for CKD in children with AIN. Conclusion IG-IC and EG-IC deposition positively correlated with severe clinical manifestations, glomerular and tubular injuries, and EG-IC deposition was risk factor for the progression of AIN in children.

Pregnancy Zone Protein as an Emerging Biomarker for Cardiovascular Risk in Pediatric Chronic Kidney Disease.

Cardiovascular disease (CVD) is a significant cause of mortality and morbidity among children with chronic kidney disease (CKD). The causes of pediatric CKD differ from those in adults, as congenital anomalies in the kidney and urinary tract (CAKUT) are the leading causes in childhood. Identifying ideal markers of CVD risk early is crucial for CKD children to improve their care. Previously, we screened differentially expressed proteins in CKD children with or without blood pressure (BP) abnormalities and identified pregnancy zone protein (PZP). In 106 children and adolescents with CKD stages G1-G4, we analyzed plasma PZP concentration. The associations between PZP and ambulatory BP monitoring (ABPM) profile, parameters of cardiac and carotid ultrasounds, indices of arterial stiffness, and nitric oxide (NO) parameters were determined. We observed that PZP positively correlated with arterial stiffness indices, beta index, and pulse wave velocity in CAKUT. CKD children with abnormalities in ABPM and night dipping displayed a higher PZP concentration than those without. Additionally, the PZP level was positively correlated with NO bioavailability. In conclusion, our results suggest PZP has differential influences on cardiovascular risk in CAKUT and non-CAKUT children. Identification of this relationship is novel in the pediatric CKD literature.

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

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Risk factors analysis of protein energy wasting in children with chronic kidney disease

Objective: To analyze the clinical characteristics and risk factors of protein energy wasting (PEW) in children with chronic kidney disease (CKD). Methods: Clinical data of 231 children with chronic kidney disease hospitalized in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to January 2023 were retrospectively analyzed to explore the incidence of PEW. According to the diagnostic criteria of CKDPEW, they were divided into a CKDPEW group and a non PEW group. The comparison between the groups was performed by independent-sample t test and Chi-squared test, and the risk factors were analyzed by multivariate Logistic regression. Results: Among the 231 children, there were 138 males and 93 females, with a visiting age of 9.9 (7.9, 16.0) years; 6 cases were in stage 1, 14 cases in stage 2, 51 cases in stage 3, 36 cases in stage 4, and 124 cases in stage 5. A total of 30 children (13.0%) with CKD PEW were diagnosed at the age of 7. 1 (3.8, 13.2) years, including 1 case in stage 1, 1 case in stage 2, 5 cases in stage 3, 5 cases in stage 4, and 18 cases in stage 5. There were a total of 201 cases (87.0%) in the non PEW group, diagnosed at the age of 11.8 (8.5, 12.2) years, including 5 cases in stage 1, 13 cases in stage 2, 46 cases in stage 3, 31 cases in stage 4, and 106 cases in stage 5. The Chi-squared test and t test showed that the systolic blood pressure, diastolic blood pressure, birth weight and carbon dioxide binding capacity of the CKD PEW group were lower than those of the non PEW group ((109±22) vs. (120±20) mmHg (1 mmHg=0.133 kPa), (72±19) vs. (79±16) mmHg, (2.9±0.5) vs. (3.2±0.6) kg, (17±4) vs. (19±4) mmol/L,t=2.85, 2.14, 0.67, 2.63, all P<0.05). Multivariate logistic regression analysis showed that carbon dioxide binding capacity and birth weight were independent protective factors of CKDPEW in children (OR=0.81 and 0.36, 95%CI=0.73-0.90 and 0.17-0.77, respectively; both P<0.01); the risk of PEW in CKD children decreased by 0.187 times for every 1 mmol/L increment in carbon dioxide binding capacity, and 0.638 times for every 1 kg increment in birth weight. Conclusions: The incidence of protein energy expenditure in children with chronic kidney disease is lower than that in the previous researches. PEW can appear in CKD 1-2 stage, and attention should be paid to it in the early stage of CKD in clinical practice. Low birth weight CKD children are susceptible to PEW, and actively correcting metabolic acidosis can reduce the risk of CKDPEW.

Early prediction of growth patterns after pediatric kidney transplantation based on height-related single-nucleotide polymorphisms.

Growth retardation is a common complication of chronic kidney disease in children, which can be partially relieved after renal transplantation. This study aimed to develop and validate a predictive model for growth patterns of children with end-stage renal disease (ESRD) after kidney transplantation using machine learning algorithms based on genomic and clinical variables. A retrospective cohort of 110 children who received kidney transplants between May 2013 and September 2021 at the First Affiliated Hospital of Zhengzhou University were recruited for whole-exome sequencing (WES), and another 39 children who underwent transplant from October 2021 to March 2022 were enrolled for external validation. Based on previous studies, we comprehensively collected 729 height-related single-nucleotide polymorphisms (SNPs) in exon regions. Seven machine learning algorithms and 10-fold cross-validation analysis were employed for model construction. The 110 children were divided into two groups according to change in height-for-age Z -score. After univariate analysis, age and 19 SNPs were incorporated into the model and validated. The random forest model showed the best prediction efficacy with an accuracy of 0.8125 and an area under curve (AUC) of 0.924, and also performed well in the external validation cohort (accuracy, 0.7949; AUC, 0.796). A model with good performance for predicting post-transplant growth patterns in children based on SNPs and clinical variables was constructed and validated using machine learning algorithms. The model is expected to guide clinicians in the management of children after renal transplantation, including the use of growth hormone, glucocorticoid withdrawal, and nutritional supplementation, to alleviate growth retardation in children with ESRD.

Vesicoureteral reflux is associated with increased risk of chronic kidney disease: A nationwide cohort study.

The association between vesicoureteral reflux (VUR) and chronic kidney disease (CKD) risk remains unestablished. We investigated the incidence of CKD in children with VUR in Taiwan and evaluated whether they had a higher risk of CKD than the general population. A nationwide population-based cohort study was conducted among children with VUR identified using Taiwan's National Health Insurance Research Database from 2000 to 2013. VUR was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. We identified the children with VUR and randomly selected comparison children according to a 1:1 ratio, matching them by age, gender, index year and comorbidity using data from the National Health Insurance Research Database. In total, 8648 children with VUR and 8648 comparison children were included. All children were followed from the study date until a diagnosis of CKD, termination of insurance, or the end of 2013. Cox proportional hazards regressions were performed to compare the hazard ratios for CKD between the 2 cohorts. Incident cases of CKD were identified. After adjustment for potential confounders, the study cohort was independently associated with a higher risk of CKD (adjusted hazard ratio, 3.78; 95% confidence interval, 2.10-7.18). This population-based cohort study indicated that children with VUR have a higher risk of CKD than those without VUR.