H THAKKAR1, S KENNEDY1,2
1University Of New South Wales, Sydney, Australia, 2Sydney Children’s Hospital, Randwick, Australia
Background: There is a paucity of evidence about the epidemiology and predictors of progression of chronic kidney disease (CKD) in adolescents.
Aim: To describe the clinical characteristics of a cohort of Australian adolescents with CKD and identify risk factors for disease progression.
Methods: This was a single-centre cohort study of adolescents aged 14 to 18 years, seen in nephrology clinics between 2007 and 2017. Demographic and clinical data were retrieved from electronic medical records. Univariate analysis was performed to identify associations between baseline covariates and progression to a composite outcome of 50% decline in glomerular filtration rate (eGFR) or stage 5 CKD. Significant covariates were included in a logistic regression model.
Results: Two hundred and fifty three adolescents with pre-endstage CKD were seen during this period. The main primary diseases were glomerulopathies (35.2%) and congenital anomalies of the kidney and urinary tract (28.9%). The majority were at CKD Stage 1 (53.3%) or 2 (26.5%) at baseline. Thirteen patients (9.3%) reached the composite outcome. Forty-two patients (30.0%) progressed by at least one CKD stage. Twenty-two of these 42 patients (52.4%) were at milder stages of CKD (Stage 1 or 2) at baseline. In univariate analysis, significant predictors of progression to the composite endpoint included CKD Stage 3 or 4 at entry (p=0.02), severe proteinuria (p=0.018), short stature (p=0.047), anaemia (p=0.07), hypoalbuminemia (p<0.005) and hyperphosphatemia (p<0.005). In the multivariate model, CKD Stage 3 or 4 (OR 5.11, 95% CI 1.15-22.60; p=0.032) and severe proteinuria (OR 9.19, 95% CI 1.26-67.16; p=0.029) were independent predictors.
Conclusion: Prior to transition, kidney function deteriorates even in adolescents at milder stages of CKD. Therefore, close follow-up during the transition period is crucial.
Heeral Thakkar is a 5th year medical student at University of New South Wales. This research was conducted as part of an Independent Learning Project in 2017.