title: Prevalence and complications of chronic kidney disease in paediatric renal transplantation: a K/DOQI perspective.
abstract: Background. Although renal transplant recipients (RTR) have been included as patients with chronic kidney disease (CKD) by the Kidney Disease Outcome Quality Initiative (K/DOQI), there are very few studies looking at CKD complications among paediatric RTR. Methods. CKD parameters of paediatric RTR with at least 1 year post-transplant follow-up were retrospectively reviewed as per K/DOQI criteria. Results. The study population included 129 RTR aged 2.7-20 (median 13.9) years, of which 67% were male and 87% Caucasian with follow-up between 1 and 14.8 (median 3.8) years. Sixty-six per cent of RTR were in either CKD Stage 3 (70) or 4 (15). A high incidence of CKD complications was identified (albuminuria 60%, anaemia 50%, acidosis 30%, hyperparathyroidism 20%, hypoalbuminaemia 16%, hyperphosphataemia 12% and hypocalcaemia 3%). Hypertension (defined as systolic blood pressure greater than 95th percentile for age and height or on any anti-hypertensive medication) was found in 53% (n = 68) of the study population, out of which 7% (n = 5) was having uncontrolled hypertension with systolic blood pressure greater than 95th percentile despite being on anti-hypertensive medication. There was an increase in complications (P = 0.0001) as well as use of CKD medications (erythropoietin-stimulating agent, sodium bicarbonate, 1-alfacalcidol and phosphate binders) across the CKD stages in RTR (P = 0.001). Conclusion. The study confirmed a high prevalence of CKD with its related complications along with increase in frequency of complications across the stages of CKD among paediatric RTR. Further multi-centre prospective studies are required to substantiate our findings and to explore whether early identification and intervention can improve renal allograft outcome.
authors.affiliation: Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS trust, Great Ormond Street, London, WC1N 3JH, UK. rajivsinha_in@yahoo.com
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sinha
authors.forename: Ahmed
authors.initials: A
authors.lastname: Saad
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies