Kidney diseases in adolescents classified according to nomenclature for kidney function and disease (KDIGO 2019): a cross-sectional study of the regional register 2013-2022 years

Aim. To determine the structure of kidney diseases in 17-year-old adolescents before their transition to the adult healthcare system using the 2019 KDIGO.

Methods. This single-center, cross-sectional descriptive study analysed a 10-year regional register of 893 adolescents hospitalized in the V.P. Sitnikova nephrology department at Voronezh Regional Children’s Clinical Hospital between 2013 and 2022. Kidney functions assessed using the CKiDbed (2009) and CKDEPI (2009) equations. Statistical significance was defined as a p<0.05.

Results. Over 70% of all hospitalizations were related attributed renal tubulo-interstitial diseases (N10- N16), congenital malformations of the urinary system (Q60-Q64), and glomerular diseases (N00-N08). The distribution of kidney conditions included CKD (36.6%), AKD without AKI (14.9%), AKD combined with CKD (8.5%), AKI (0.4%), AKI combined with CKD (1.3%), and no kidney disease. CKD was more prevalent in males (69.5%, vs 45.3% in females, p<0.001), while AKD was more common in females (38.0% vs 15.1% in males). GFR calculation discrepancies between CKiDbed and CKD-EPI equations led to changes in GFR categories and CKD/AKD stages 55.8% of adolescents, with the largest median discrepancy in males (37 ml/min/1.73 m2).

Conclusions. the study classified kidney diseases in 17-year-old, revealing gender differences and highlighting the impact of varying GFR calculation methods of disease staging. The findings emphasized the need for consistent GFR assessment approaches across pediatric and young adult healthcare.

1. Levey A.S., Eckardt K.U., Dorman N.M., et al. Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2020. 97(6):1117-1129. doi:10.1016/J.KINT.2020.02.010

2. Lameire N.H., Levin A., Kellum J.A., et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2021. 100(3):516-526. doi:10.1016/J.KINT.2021.06.028

3. Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference: translation from English E.V. Zakharova. Nephrologу and Dialуsis. 2020. 22(3):271-292. doi:10.28996/2618-9801-2020-3-271-292

4. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Translated into Russian by A.Y. Zemchenkov and A.S. Rumyantsev edited by E.V. Zakharova. Nephrologу and Dialуsis. 2023. 25(1):11-25. doi: 10.28996/2618-9801-2023-1-11-25

5. Kulakova E.N., Nastausheva T.L., Kondratjeva I.V., et al. Transition of Adolescents with Chronic Kidney Disease to Adult Health Service: Scoping Review. Current Pediatrics. 2021. 20(1):38-50. https://doi.org/10.15690/vsp.v20i1.2235

6. Kulakova E.N., Nastausheva T.L., Zvyagina T.G. et al. Problems in the estimation of the glomerular filtration rate in adolescents and young adults: a narrative review and examples from clinical practice. Nephrologу and Dialуsis. 2021. 23(4):472-488. doi: 10.28996/2618-9801-2021-4-472-488

7. Kulakova E.N., Savchenko A.P., Nastausheva T.L., et al. Adolescents with urinary system diseases in their final stage of pediatric nephrology care: a cross sectional study based on a regional hospital's 10-year database. Pediatria n.a. G.N. Speransky. 2023. 102 (4): 28-39. – doi: 10.24110/0031-403X-2023-102-4-28-39

8. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007. 147(8):573-577. doi:10.7326/0003-4819-147-8-200710160-00010

9. Kidney disease: Improving global outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013. 3:1-150. doi:10.1038/kisup.2012.76

10. Batiushin M.M., Kasimova I.S., Gavrilov D.V., et al. Prevalence of chronic kidney disease according to the retrospective cohort study “CKD epidemiology” (Kirov City). Nephrologу and Dialуsis. 2021. 23(2):192-202. doi:10.28996/2618-9801-2021-2-192-202

11. Kellum J.A., Lameire N., Aspelin P., et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injuryKidney Int Suppl. 2012. 2(1):1-138. doi:10.1038/kisup.2012.1

12. Levey A.S. Defining AKD: The Spectrum of AKI, AKD, and CKD. Nephron. 2022. (146):302-305. doi:10.1159/000516647

13. Schwartz G.J., Muñoz A., Schneider M.F., et al. New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology. 2009. 20(3):629-637. doi:10.1681/ASN.2008030287

14. Levey A.S., Stevens L.A., Schmid C.H., et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009. 150(9):604-612. doi:10.7326/0003-4819-150-9-200905050-00006

15. Laszczyńska O., Azevedo A., Ferreira-Almeida M., et al. Conversion methods for modified Jaffe reaction assays of serum creatinine. Porto Biomed J. 2020. 5(3):1-4. doi:10.1097/j.pbj.0000000000000072

16. Kulakova E.N., Nastausheva T.L., Stahurlova L.I., et al. Nomenclature of Kidney Diseases in Pediatric Practice (Questions and Answers). Voronezh: Kvarta, 2022. 105 p. Accessed November 04, 2023. https://www.elibrary.ru/item.asp?id=49748357

17. James M.T., Levey A.S., Tonelli M., et al. Incidence and Prognosis of Acute Kidney Diseases and Disorders Using an Integrated Approach to Laboratory Measurements in a Universal Health Care System. JAMA Netw Open. 2019. 2(4):e191795. doi:10.1001/jamanetworkopen.2019.1795

18. Patel M., Hornik C., Diamantidis C., et al. Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury. Pediatric Nephrology. 2023. 38(10):3465-3474. doi:10.1007/s00467-023-05997-9

19. Shutov A.M., Efremova E.V., Menzorov M.V. Pochechnyy kontinuum: problemy klassifikatsii [Renal continuum: Classification problems]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2023. 1:43–49. doi: 10.34014/2227-1848-2023-1-43-49

20. Suprunovich K.S., Paltyshev I.A., Zakharenko A.A., et al. Onconephrology: acute kidney disease after preventive ileostomy in a patient with colorectal cancer. Nephrology (Saint-Petersburg). 2023. 27(1):102-107. https://doi.org/10.36485/1561-6274-2023-27-1-102-107

21. Kulakova E.N., Nastausheva T.L., Kondratjeva I.V. Definition and criteria of acute kidney disease: scoping review. Nephrologу and Dialуsis. 2020. 22(1):71-83. doi:10.28996/2618-9801-2020-1-71-83

22. Avner E.D., Harmon W.E., Niaudet P., et al. Pediatric Nephrology. Springer Berlin Heidelberg; 2015. doi:10.1007/978-3-662-43596-0

23. The Union of Pediatricians of Russia, Creative Association of Pediatric Nephrologists, Russian Transplant Society. Clinical guidelines “Chronic kidney disease”. ICD-10: N18.1, N18.2, N18.3, N18.4, N18.5, N18.9. Age category: Children; 2022. Accessed November 04, 2023. https://cr.minzdrav.gov.ru/recomend/713_1

24. Pottel H., Björk J., Courbebaisse M., et al. Development and Validation of a Modified Full Age Spectrum CreatinineBased Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data. Ann Intern Med. 2021. 174(2):183-191. doi:10.7326/M20-4366

25. Schwaderer A.L., Maier P., Greenbaum L.A., et al. Application of GFR estimating equations to children with normal, near-normal, or discordant GFR. Pediatric Nephrology. Published online 2023. doi:10.1007/s00467-023-06045-2

26. Inker L.A., Tighiouart H., Adingwupu O.M., et al. Performance of GFR Estimating Equations in Young Adults. American Journal of Kidney Diseases. Published online September 2023. doi:10.1053/j.ajkd.2023.06.008

27. Filler G., Ahmad F., Bhayana V., et al. Limitations of U25 CKiD and CKD-EPI eGFR formulae in patients 2–20 years of age with measured GFR &gt; 60 mL/min/1.73 m2–a crosssectional study. Pediatric Nephrology. Published online October 16, 2023. doi:10.1007/s00467-023-06185-5

28. Pierce C.B., Muñoz A., Ng D.K., et al. Age- and sexdependent clinical equations to estimate glomerular filtration rates in children and young adults with chronic kidney disease. Kidney Int. 2021. 99(4):948-956. doi:10.1016/j.kint.2020.10.047

29. Delanaye P., Glassock R.J., Pottel H., et al. An Age-Calibrated Definition of Chronic Kidney Disease: Rationale and Benefits. Clin Biochem Rev. 2016. 37(1):17-26. Accessed November 04, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810758/

30. Raikevich-Liachovskaya O.V., Sukalo A.V., Baiko S.V. Problematic issues of optimizing the transfer of renal transplant recipients from pediatric to adult health care (literature review). Nephrology (Saint-Petersburg). 2023. 27(2):21-28. https://doi.org/10.36485/1561-62742023-27-2-21-28

31. Makovetskaya G.A., Poretskova G.Yu., Mazur L.I., et al. Adolescent patient with chronic kidney disease: readiness for transfer from pediatric into adult nephrology healthcare system, challenges of the transition. Bibliographical review and Authors’ own observations. Pediatria n.a. G.N. Speransky. 2023. 102 (4): 16-27. – doi: 10.24110/0031-403X-2023-102-4-16-27