Regional variation of underlying kidney diseases in children undergoing chronic kidney replacement therapy around the globe

Background There is a scarcity of demographic information regarding the distribution of the diseases leading to kidney failure (KF) in children living in the emerging world. We used data from international, regional and national registries to provide a global overview of the underlying disease spectrum in children commencing kidney replacement therapy (KRT). Methods We analyzed KF causes among 23,620 children and adolescents commencing maintenance KRT in 80 countries, using data from the IPNA Global KRT Registry (including ESPN/ERA Registry), the International Pediatric Dialysis Network (IPDN), the United States Renal Data System (USRDS), and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The analysis considered geographic region, country-level gross national income (GNI), average annual temperature, and patient age. Results Marked regional differences were observed in the distribution of KF causes. Immune-mediated glomerulopathies (GP) were most common in Southeast Asia, hereditary nephropathies in the Middle East, Africa, and Europe, and systemic GP in Northeast Asia and Latin America. In 14% of cases the cause of KF was unknown, with the highest proportion in Northeast Asia. Disease patterns were also influenced by the countries’ GNI and average yearly temperature; immune-mediated GP accounted for 43% of diagnoses in low-income countries and were more frequent in warmer climates. Among younger children, congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies were the predominant cause of KF, whereas adolescents more commonly presented with immune-mediated GP. Conclusion There is significant global variability in the spectrum of diseases leading to pediatric KF, which is partially attributable to genetic, environmental, and macroeconomic factors.