Epidemiological Pattern of Chronic Kidney Diseases among Children- Khartoum State-2015

Abstract

Abstract:

Introduction: chronic kidney disease is a major public health problem worldwide,

and chronic renal failure in Sudanese children have high mortality rate, more than half

of the patient followed progress to end stage renal disease. End stage renal disease is

a devastating disorder associated with excessive mortality and cardiovascular

morbidity, and specific problems occur in children, such as impaired growth and

psychosocial adjustment.

Objectives: To study the epidemiological pattern of chronic kidney disease among

children with End stage renal disease on regular haemodialysis.

Methodology :This was a descriptive cross sectional multicenter study among children

with end stage renal disease on regular haemodialysison dialysis pediatric nephrology

unit, Gaffer Ibn auf Hospital, Nora Center and Omdurman Teaching Hospital dialysis

center January -July 2015, Data were collected with standardized administrated

questionnaire and were analyzed using SPSS (Statistical Package for the Social Science)

version 21.Chi squared and p value calculated with value of 0.05 was set for statistical

significance

Results: among the 100 children with End stage renal disease on regular haemodialysis

69% had at least on risk factor for chronic kidney disease, male were 2.2 times more to

have it compared to female (odd ratio 2.2, P value 0.1) and congenital anomaly of the

kidney and urinary tract were found in 26% of children and male were 5.6 times more to

have it. Family history of kidney disease was found in 25%, and 21% had perinatal risk

factor. 37% had history of repeated urinary tract infection, 20% had history of proteinuria

during childhood and 19% had history of hematuria. Mean age at diagnosis ( mean age at

first presentation) was 10.07 year +_ 3.68SD (range 1year-18year)) and was strongly

related to duration from diagnosis till initiation of hemodialysis (which was less than one

month in 55% of patient) as An increase in age at diagnosis by one year decreased the

time for progression to hemodialysis by approximately 3 month (p value, .000)., also an

increase in age at the time of study by one year increased the time for progression to

hemodialysis by approximately 2 month, (p value, .000). The presence of congenital

anomalies of the kidney and urinary tract decreased time for progression to hemodialysis

II

by approximately 8 month (p value, .000). An association was found between duration

from diagnosis till initiation of hemodialysis and mother education (Chi-Square., 38.59 p

value .040)), and facility where first diagnosed (Chi-Square20.821 p value .001). Nonavailability

of donor alone was the main barrier for transplantation (43%), were (9%)

had financial barrier and (17%) had both barriers (donor non-availability and financial

barrier). 11% were waiting for transplantation (waiting list) and 10% had clinical barrier.

Conclusion: Most patients on dialysis at Khartoum state were from other Sudan state,

and mostly they came from rural areas, seeking emergency care and half of the patient

(55%) present with end stage renal disease that required emergency hemodialysis with in

few week after diagnosis. The mean age at diagnosis was 10 year +- 3, (range 1-18), The

duration from diagnosis till initiation of hemodialysis was associated with mother

education (Chi-Square., 38.59 p value .040)), and facility where first diagnosed (ChiSquare20.821

p value .001) and The presence of congenital anomalies of the kidney and

urinary tract decreased time for progression to hemodialysis by approximately 8 month (p

value, .000) also An increase in age at diagnosis by one year decreased the time for

progression to hemodialysis by approximately 3 month, (p value, .000). The late

presentation associated with donor unavailability and financial difficulties was the main

barrier for transplantation in those children

Recommendations: Targeting rural areas with Preventive and curative services that

address chronic kidney disease among children is more effective as most of the children

were from these areas, early detection and intervention are the most cost effective

strategies that target CKD. and as more than half of the patient present with end stage

renal disease that rabidly progress to hemodialysis The need to activate surveillance

program for CKD stages 4 and 5 to monitor the magnitude and the care of this high-risk,

high-cost population, and possibly to reduce both the risk of progression to end stage

renal disease and the cost of dialysis and transplantation. The need to notice the problem

of children on hemodialysis to alleviate the barrier for transplantation should be

addressed.