TOPLINE

Children with spina bifida were diagnosed with chronic kidney disease (CKD) and end-stage renal disease (ESRD) far more often and at younger ages than children in the general population, with onset occurring about 5-7 years earlier.

METHODOLOGY

• Although kidney disease is common and a leading cause of morbidity and mortality in patients with spina bifida, the timing of onset in pediatric patients, as well as key predictors of kidney morbidity, is not clear.
• Researchers conducted a population-based retrospective cohort study of children born in Ontario, Canada, from April 1992 to March 2023 to estimate the incidence, age at onset, and clinical risk factors associated with kidney disease among children with spina bifida.
• The cohort included 4,380,749 publicly insured children: 12,868 with spina bifida (median age at diagnosis, 1 year; 48.4% girls) and 4,367,881 without spina bifida (48.7% girls).
• The primary outcome was CKD identified via standard diagnosis codes; secondary outcomes were long-term dialysis and/or kidney transplant as indicators of ESRD.
• The median follow-up duration was 15 years from birth.

TAKEAWAY

• Children with spina bifida had about a ninefold higher incidence rate of CKD than those without spina bifida (2.7 vs 0.3 cases per 1000 person-years; rate ratio [RR], 8.8; 95% CI, 8.1-9.6).
• The incidence rate of ESRD was 30-fold higher among children with spina bifida than among those without the condition (RR, 30.0; 95% CI, 23.1-38.8).
• Children with vs without spina bifida were diagnosed with CKD earlier (median age, 5 years vs 10 years) and experienced progression to ESRD at a younger age (median age, 8 years vs 15 years; P < .001 for both).
• Among children with spina bifida, a higher risk of developing CKD was associated with male sex (vs female sex; adjusted hazard ratio [aHR], 1.2), a greater comorbidity burden (one to two comorbidities vs none: aHR, 9.57; three or more comorbidities vs none: aHR, 31.99), presence of diabetes (aHR, 2.4), upper tract calculi (aHR, 1.8), each additional complex urinary tract infection (aHR, 1.1), and prior urologic surgery (aHR, 2.1).

IN PRACTICE

“These findings highlighted a large disparity in kidney morbidity among pediatric patients with spina bifida, underscoring the importance of vigilant early surveillance in this population,” the authors of the study wrote.

“Shared decision-making discussions — including the rationale for ongoing surveillance and the importance of early CKD detection — should be an explicit part of clinical visits, particularly as patients transition from pediatric to adult care,” experts wrote in a commentary accompanying the journal article.

SOURCE

The study was led by Hannah S. Thomas, MBChB, University of Toronto, Toronto, Ontario, Canada. It was published online in JAMA Network Open.

LIMITATIONS

The study used administrative health data, which may have introduced misclassification. It could not determine whether CKD or ESRD was directly attributable to spina bifida or identify underlying mechanisms. Additionally, creatinine-based estimates of kidney function used to detect CKD may have been less reliable in children with spina bifida.

DISCLOSURES

The study was supported by the University of Toronto Functional Research Program, and the authors disclosed having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.