Clinical Features Of 549 Children With Chronic Kidney Disease And Risk Factors For Left Ventricular Hypertrophy

Objective:We analyzed the case data of 549 children with chronic kidney disease(CKD)to discuss the clinical characteristics of children with CKDin our center and the risk factors associated with CKDcombined with left ventricular hypertrophy(LVH),in order to provide a clinical basis for timely diagnosis,comprehensive management and improvement of the prognosis of children with CKD.This study provides a clinical basis for timely diagnosis,comprehensive management and improvement of prognosis of children with CKD.Methods:Retrospective analysis of children hospitalized in the Department of Nephrology and Rheumatology and Department of Pediatric Surgery of Guiyang Maternal and Child Health Hospital between January 2017 and June 2021 included 549 children who met the diagnostic criteria for CKD,and collected clinical data on age,gender,ethnicity,onset symptoms,duration of disease,laboratory indices,imaging and pathological examinations,and treatment of all children to analyze their general condition,We analyzed their general condition,etiological composition,pathological typology,complications and treatment.The children were grouped according to whether they had combined LVH or not,and the clinical data were compared between the two groups,and the risk factors for combined LVH in children with CKDwere screened using univariate and multifactorial logistic regression models.Results:1.The median age of onset was 6.38 years,and the median duration of disease was1 year,and by age grouping,children aged 0～3 years,3～6 years,6～12 years,and 12～18years accounted for 30.42%,15.85%,40.80%,and 12.93% of the total number of children,respectively.The proportion of children aged 6～12 years was the highest.There were 14 ethnic groups among the children,among which 345 cases(62.84%)were Han Chinese and 73 cases(13.30%)were Hmong and 40 cases(7.29%)were Buyi among the minority ethnic groups,which accounted for a larger proportion.2.Grouped by etiology,there were 279 cases of acquired glomerular diseases(50.82%)and 237 cases of congenital anomalies of the kidney and urinary tract(CAKUT)(43.17%).Glomerular and unspecified diseases accounted for a higher proportion of causes in children aged 6～18 years with CKD than in children aged under6 years,and CAKUT accounted for a higher proportion of causes in children aged under6 years than in children aged 6～18 years,with statistically significant differences(P<0.05 for both);the differences in the proportion of causes of tubulointerstitial disease and inherited metabolic diseases in children of different age groups were not statistically significant(P>0.05).Glomerular diseases accounted for a higher proportion of causes in children with CKD stage 1 than in children with CKD stage2～5,and the difference was statistically significant(P<0.001).Meanwhile,CAKUT,genetic metabolic diseases and diseases of unknown cause accounted for a higher proportion of causes in children with CKD stages 2～5 than in children with CKD stage1,with statistically significant differences(P<0.001).The difference in the proportion of tubulo-interstitial disease in the etiology of children in both groups was not statistically significant(P>0.05).3.There were 445 children with symptomatic onset of CKD,among which,268(48.81%)had urinary symptoms as the first symptom,177(32.24%)had non-urinary symptoms,and 99 of 104 children with no obvious symptoms had CAKUT as the primary disease.4.Among 88 children with CKD stages 2～5,those with CKD stages 2～4complicated by low weight,hypertension,anemia,and hyperphosphatemia were significantly lower than those with CKD stage 5,and the differences were all statistically significant(P<0.01).Metabolic acidosis,LVH,and secondary hyperparathyroidism were not statistically significant(P>0.05)in CKD stages 2 to 4and during CKD5.5.Among the 549 children with CKD,154 had renal biopsies,with a renal biopsy rate of 28.05%,and the renal biopsy rate in children with CKD due to primary glomerular disease was 40.37%.glomerulosclerosis(FSGS)and sclerosing glomerulonephritis were more common in children with CKD stages 2～5 than in children with CKD stages 2-5,and the differences were statistically significant(P <0.05).6.Renal replacement therapy accounted for 87.50% in CKD stage 5,of which hemodialysis(HD)accounted for 48.72% and HD combined with peritoneal dialysis accounted for 28.21%.7.Among 136 children with CKD who had perfected cardiac ultrasound,the differences in these indicators of hemoglobin(Hb),blood phosphorus,blood bicarbonate,blood creatinine,urea nitrogen,and CKD stage were statistically significant in the LVH group compared with the non-LVH group(P < 0.01).One-way logistic regression analysis revealed that Hb≤90g/L,high phosphorus,metabolic acidosis,CKD stage 2～5,and hypertension may be risk factors for the development of LVH in children with CKD;multivariant logistic regression analysis further showed that Hb≤90g/L(OR=2.564,95% CI 2.564-32.156,P<0.05),and CKD stages 2～5(OR=19.116,95% CI 3.579-102.102,P<0.05),and hypertension(OR=31.041,95% CI4.933-195.328,P<0.001)were independent risk factors for combined LVH in children with CKD.Conclusions:1.The most common cause of CKD children in our center was glomerulonephritis,followed by CAKUT.2.CAKUT was the most common cause of CKD in children aged 0-6 years,while glomerulonephritis was the most common cause of CKD in children aged 6-18 years.3.CAKUT accounts for a higher proportion of causes in children with CKD stages2-5 and asymptomatic onset.4.Among children with CKD caused by glomerular diseases,the pathological type of purpura nephritis is higher in children with CKD stage 1,while FSGS and sclerosing glomerulonephritis are higher in children with CKD stage 2～5.5.Renal replacement therapy is based on hemodialysis,and the best replacement therapy needs to be selected according to the condition of the child.6.Compared with children with CKD stage 2～4,children with CKD stage 5 have a higher incidence of low weight,anemia,hyperphosphatemia and hypertension complications.7.Hb≤90g/L,CKD stage 2～5,and hypertension are risk factors for combined LVH in children with CKD.