Childhood Kidney Disease May Raise Adulthood ESRD Risk

Individuals who had childhood kidney disease that resolved prior to adolescence still have an increased risk of developing end-stage renal disease (ESRD) in adulthood, a new study found.

Using linked data from the Israeli ESRD registry, the researchers evaluated 1,521,501 Israeli adolescents with normal renal function without hypertension who were assessed prior to compulsory military service between 1967 and 1997. Follow-up lasted 30 years.
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Childhood kidney disease was defined as the presence of congenital anomalies of the kidney and urinary tract, pyelonephritis, or glomerular disease during childhood. Hazard ratios (HRs) for the association of childhood kidney disease with adulthood ESRD were estimated via Cox proportional-hazards models.

Findings showed that 2490 participants developed ESRD over the course of follow-up. The HR for ESRD was 4.19 in those with a history of any childhood kidney disease.

The researchers found that the associations of congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease with adulthood ESRD risk were similar in magnitude, with multivariable-adjusted HRs of 5.19, 4.03, and 3.85, respectively.

They also noted that those with a history of childhood kidney disease had an increased risk of ESRD onset at a younger age during adulthood, with an HR of 10.40 for ESRD onset in adults younger than age 40 years.

“A history of clinically evident kidney disease in childhood, even if renal function was apparently normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences,” the researchers concluded.

—Christina Vogt

Reference:

Calderon-Margalit R, Golan E, Twig G, et al. History of childhood kidney disease and risk of adult end-stage renal disease. N Eng J Med. 2018;378:428-438. doi:10.1056/NEJMoa1700993.