Risk factors for childhood chronic kidney disease in Southern Israel: a population -based study.

Background: Childhood CKD prevalence (assessed as 75 cases per million in developed countries) and risk factors are not well defined. We ascertained childhood CKD epidemiology and perinatal risk factors, based on a large computerized medical records (CMR) database that covers most of Southern Israel`s population.

Methods: Pre- and post-natal CMR of all Clalit Health Services southern district patients, born between 2001-2015 who had at least one serum creatinine tested, were analyzed. "Ever–CKD" was defined as ≥ 2 eGFR values < 90 ml/min/1.73m2 beyond the age of 6 months, more than 3 months apart. Last CKD status (Non-CKD, aborted CKD and current CKD) was determined on March 2019.

Results: Out of 100,173 eligible patients we identified 131 (0.13 %) individuals with "ever CKD", 75 of them (57.3%) turned into aborted CKD. Most (61.8%) "ever-CKD" children had their first abnormal eGFR below the age of 2 years. On univariate and multiple logistic regression analysis, CAKUT related diagnoses, maternal oligohydramnios, poor fetal growth, low birth weight and prematurity were the most significant risk factors for ever-CKD [adjusted OR (95%CI): 5.48 (4.16-7.2), 1.82 (1.63-2.44), 1.92 (1.55- 2.38), 0.42 (0.37-0.48), 0.93 (0.91-0.95) respectively]. In subgroup analyses comparing current vs aborted CKD, CAKUT related diagnoses (57.1% vs 22.7%) and any glomerulopathy (19.6% vs 5.3%) were significantly more common in the current CKD group.

Conclusions: CKD prevalence in children (740/million) in Southern Israel is higher than previously reported, even after excluding the aborted CKD cases. Perinatal risk factors increase the risk to develop CKD already in childhood age