Ronit Calderon-Margalit1, Eliezer Golan1, Gilad Twig1, Adi Leiba1, Dorit Tzur1, Arnon Afek1, Karl Skorecki1, Asaf Vivante1. 1. From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts.
Abstract
BACKGROUND: The long-term risk associated with childhood kidney disease that had not progressed to chronic kidney disease in childhood is unclear. We aimed to estimate the risk of future end-stage renal disease (ESRD) among adolescents who had normal renal function and a history of childhood kidney disease. METHODS: We conducted a nationwide, population-based, historical cohort study of 1,521,501 Israeli adolescents who were examined before compulsory military service in 1967 through 1997; data were linked to the Israeli ESRD registry. Kidney diseases in childhood included congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease; all participants included in the primary analysis had normal renal function and no hypertension in adolescence. Cox proportional-hazards models were used to estimate the hazard ratio for ESRD associated with a history of childhood kidney disease. RESULTS: During 30 years of follow-up, ESRD developed in 2490 persons. A history of any childhood kidney disease was associated with a hazard ratio for ESRD of 4.19 (95% confidence interval [CI], 3.52 to 4.99). The associations between each diagnosis of kidney disease in childhood (congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease) and the risk of ESRD in adulthood were similar in magnitude (multivariable-adjusted hazard ratios of 5.19 [95% CI, 3.41 to 7.90], 4.03 [95% CI, 3.16 to 5.14], and 3.85 [95% CI, 2.77 to 5.36], respectively). A history of kidney disease in childhood was associated with younger age at the onset of ESRD (hazard ratio for ESRD among adults <40 years of age, 10.40 [95% CI, 7.96 to 13.59]). CONCLUSIONS: A history of clinically evident kidney disease in childhood, even if renal function was apparently normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences.
BACKGROUND: The long-term risk associated with childhood kidney disease that had not progressed to chronic kidney disease in childhood is unclear. We aimed to estimate the risk of future end-stage renal disease (ESRD) among adolescents who had normal renal function and a history of childhood kidney disease. METHODS: We conducted a nationwide, population-based, historical cohort study of 1,521,501 Israeli adolescents who were examined before compulsory military service in 1967 through 1997; data were linked to the Israeli ESRD registry. Kidney diseases in childhood included congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease; all participants included in the primary analysis had normal renal function and no hypertension in adolescence. Cox proportional-hazards models were used to estimate the hazard ratio for ESRD associated with a history of childhood kidney disease. RESULTS: During 30 years of follow-up, ESRD developed in 2490 persons. A history of any childhood kidney disease was associated with a hazard ratio for ESRD of 4.19 (95% confidence interval [CI], 3.52 to 4.99). The associations between each diagnosis of kidney disease in childhood (congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease) and the risk of ESRD in adulthood were similar in magnitude (multivariable-adjusted hazard ratios of 5.19 [95% CI, 3.41 to 7.90], 4.03 [95% CI, 3.16 to 5.14], and 3.85 [95% CI, 2.77 to 5.36], respectively). A history of kidney disease in childhood was associated with younger age at the onset of ESRD (hazard ratio for ESRD among adults <40 years of age, 10.40 [95% CI, 7.96 to 13.59]). CONCLUSIONS: A history of clinically evident kidney disease in childhood, even if renal function was apparently normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences.
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