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Thursday, 19 May 2016 12:21

Clinical Research: Chronic Kidney Disease: Assessment of progression, co-morbidities and quality of life in Indian children

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image KamathName: Nivedita Kamath

Hospital / Affiliation: St. John's Medical College Hospital, Bangalore

Home Country: India

Host Country: India 

Year: 2013

Status of your program: IN PROGRESS

 

 

Title of the project: 

Chronic Kidney Disease: Assessment of progression, co-morbidities and quality of life in Indian children

Topics: 

Chronic Kidney Disease, Pediatric Nephrology 

 

Short description of the project or abstract:

Chronic kidney disease in children in developing countries is often diagnosed late and children are referred in late stages with severe co-morbidities. The chronic disease not only impacts the quality of life of the affected child but also the family. There is no prospective data from developing countries regarding the risk factors associated with progression, the associated co-morbidities and the quality of life in children with chronic kidney disease.
This is a prospective study conducted over for a period of two years in the Department of Pediatric Nephrology, St. John’s Medical College, Bangalore. The baseline demographic characteristics and treatment details of the cohort was recorded. The modifiable risk factors like proteinuria, blood pressure and other co-morbidities like anemia, mineral bone disease and cardiovascular disease were noted. The quality of life was assessed in these children using the PedsQL questionnaire.

Seventy four children were recruited into the study. Renal hypodysplasia/aplasia accounted for the majority of kidney diseases resulting in chronic kidney disease. Twenty percent of children with chronic kidney disease progressed to ESRD in one year with a median rate of decline in GFR being 3.3 ml/min/1.73m2 per year. The severity of proteinuria at baseline is a significant modifiable risk factor whereas, etiology of CKD and baseline GFR were important non modifiable risk factors for progression. Hypertension was prevalent in 62% of our cohort but did not influence progression of disease.
Anemia was prevalent in a third of our cohort and low haemoglobin levels were significantly associated with lower GFR. Vitamin D deficiency was universal in our cohort and showed significant improvement with treatment. Hyperparathyroidism which correlated with vitamin D levels at recruitment, significantly improved with correction of vitamin D deficiency.
Hyperlipidemia was seen in two thirds of our patients. Almost half of our cohort had left ventricular hypertrophy. Anemia and hyperparathyroidism were significantly associated with left ventricular hypertrophy. The left ventricular mass index did not correlate significantly with the GFR or with blood pressure. Structural change in the carotid intimal thickness was high in our cohort and was significantly associated with higher systolic and diastolic blood pressure.
The parent’s proxy physical and psychosocial scores were significantly influenced by lower levels of GFR, lower height z scores and lower socioeconomic status. The psychosocial scores of both the parent and the child were significantly lower in families belonging to the lower socioeconomic group.

Conclusions:
The median rate of progression in our cohort was 3.3ml/min/1.73m2 per year. Glomerular disease, proteinuria and lower baseline GFR were significant risk factors for progression. Anemia and iron deficiency were prevalent in one third of the population. Vitamin D deficiency was universal in our cohort and was a significant contributor to hyperparathyroidism. Left ventricular hypertrophy was seen in half of the cohort and anemia was a significant risk factor for left ventricular hypertrophy. Lower socioeconomic status, lower height z scores and lower levels of GFR were associated with lower quality of life scores.

 

Learning or Research objectives:

  •  To study the rate of progression of stages II to IV CKD and identify modifiable and non- modifiable risk factors for progression of CKD in children
  • To assess the severity of co-morbidities like anemia, mineral bone disease and cardiovascular disease in these children
  • To study the impact of disease on Quality of life of children with stages II to IV CKD

 

Additional Info

  • Year: 2013
  • Status: In progress
  • Partners: ISN only
  • Region: South Asia
  • Country: India
  • Topics: CKD, Paediatric nephrology
Read 7195 times Last modified on Friday, 17 February 2017 12:28

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