CKD Following Kidney Transplantation in Children and Adolescents

Background

There is under-recognition of comorbid conditions associated with chronic kidney disease (CKD) in children and adolescents after successful renal transplantation.

Study Design

Retrospective cross-sectional.

Setting & Participants

Children and adolescents aged 1 to 20 years with kidney disease in a transplant (n = 45) and native-kidney-disease cohort (n = 102) matched for CKD stages. CKD stages were assigned using glomerular filtration rate measured by means of nuclear medicine studies. A single pediatric nephrology group cared for all patients.

Predictor

History of kidney transplantation.

Outcomes

Complications of CKD (anemia, hypertension, acidosis, and bone mineral metabolism).

Results

The transplant (38% CKD stages 1 to 2, 62% CKD stages 3 to 5) and native-kidney (55% CKD stages 1 to 2, 45% CKD stages 3 to 5) cohorts were similar in demographic and baseline profiles; 68% of transplant recipients had 2 or more complications compared with 29% of native-kidney patients. After adjusting for baseline variables, the odds of having anemia was greater in transplant recipients (odds ratio, 9.7; 95% confidence interval, 3.9 to 24.6) at all CKD stages. The odds of having hypertension was particularly greater (odds ratio, 12.9; 95% confidence interval, 3.4 to 49.4) in transplant recipients with stages 1 to 2 CKD. No significant differences in bone mineral metabolism or acidosis were seen between groups.

Limitations

Retrospective cross-sectional design limits availability of data; lack of consistent protocols introduces treatment bias among physicians.

Conclusions

Children with CKD after transplantation appear to have greater odds of having anemia and hypertension than those with CKD in native kidneys. We suggest that increased awareness and attention to these 2 modifiable risk factors for CKD and cardiovascular disease may improve outcomes after transplantation.

Index Words: Pediatrics, kidney transplant, chronic kidney disease, burden of disease, outcomes