Chronic Kidney Disease in Children: A Decade-long Review of Aetiology and Complications from a South Indian Centre

Introduction: Chronic kidney disease (CKD), as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, involves structural or functional kidney abnormalities lasting over three months. In children, CKD presents with diverse aetiologies and early complications that impact long-term outcomes. Paediatricians must improve the early identification of CKD and related risk factors that contribute to morbidity considering the late detection of CKD and its comorbidities. This study has been designed to study the aetiology, clinical features, and complications of CKD in children. Methods: A retrospective analysis of 91 children aged one month to 18 years, diagnosed with stage 2 – 5 CKD between 2012 and 2022, was conducted. Results: The median age at diagnosis of CKD was nine years (3.3, 13), with a male-to-female ratio of 2.9:1. Median estimated glomerular filtration rate (eGFR) was 25.6 ml / min / 1.73 m² (12.72, 40.95). CKD staging showed 5.5% in stage 2, 40.7% in stage 3, 23.1% in stage 4, and 30.7% in stage 5 with 18.7% requiring dialysis. Pallor (86.8%), short stature (74.7%), and hypertension (70.3%) were the most common clinical findings. Congenital anomalies of kidney and urinary tract (CAKUT) were the predominant aetiology (39.6%), followed by hereditary (11.0%), glomerular (8.8%), tubulopathy (5.5%), and unknown (35.1%). Common complications included hyperkalaemia (21.0%), hypocalcaemia (48.3%), hyperphosphatemia (20.9%), secondary hyperparathyroidism (57.1%), vitamin D deficiency (27.3%), and hypoalbuminemia (27.3%). Hypocalcaemia and hyperphosphatemia increased with advancing CKD stages (P = 0.008 and < 0.001). Anaemia was present in 91.2%, with increasing need for transfusion and erythropoietin therapy as CKD stage advanced (P < 0.001). Short stature also increased significantly with CKD progression (P = 0.05). Conclusions: CAKUT were the most common aetiology. Anaemia, hypertension, and short stature were the predominant complications, all of which increased with CKD severity.