Etiology and prognosis of chronic kidney disease in children: Roma ethnicity and other risk factors

(2014) Gabriel Kolvek

Promotor: S.A. Reijneveld, L. Podracka

Copromotor: J.P. van Dijk, J. Rosenberger


Kolvek Thesis 200x250 This study focuses on the epidemiology of chronic kidney diseases (CKD) in children. Trends in occurrence show that during the past decade the incidence and prevalence rates of end-stage renal disease (ESRD) in Slovak children has remained stable. A comparison with neighboring countries and with the European average showed no significant differences in incidence, while the prevalence in Slovakia was significantly lower than the European average. This may suggest a somewhat increased mortality in Slovakia among this patient group. Furthermore, we explored Roma ethnicity as a risk factor for ESRD. ESRD in children and adults was found to occur significantly more frequently in Roma than in non-Roma in all age groups. The age prevalence of ESRD in Roma was 2.85-times higher than in the majority population after adjustment for differences in age composition. A genetic propensity toward renal failure in Roma may play a role, as may poorer control of other risk factors for ESRD in these Roma. This may hold true in particular for those Roma facing socioeconomic adversity. Roma were found to be relatively underrepresented at medical services in the earlier stages of CKD but overrepresented among patients with advanced CKD (i.e. ESRD). Morevoer, Roma were overrepresented in the case of specific, relatively rare, nephropathies. Finally, we found that a substantial proportion of children with a solitary functioning kidney (SFK) developed renal injury during childhood, especially in the case of a structural anomaly in the SFK.