Incidence of pediatric kidney failure decreased in Israel in the past 30 years
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In the past 30 years, kidney failure incidence has decreased to an average of 9.1 cases per million age-related population, according to data published in the Clinical Journal of the American Society of Nephrology.
Further, researchers identified a higher rate of incidence among Arab and Druze children than Jewish children in Israel.
“Variability in kidney failure among ethnic groups in Israel has been suggested before. Specifically, previous studies have reported a few rare genetic diseases that presented predominantly among children from Arab or Druze ethnicities, as well as a disproportionally high prevalence of kidney failure compared to the general population,” Lilach C. Regev-Epstein, MD, from the department of pediatrics B at the Edmond and Lily Safra Children's Hospital and Sheba Medical Center in Israel, and colleagues wrote. “Nevertheless, as the previous studies where single-centered and reported findings regarding a single disease or treatment modality, a national comprehensive study was needed to evaluate the full spectrum and variability of Israeli childhood kidney failure disease.”
In a retrospective national cohort study, researchers examined data of 759 children with kidney failure requiring maintenance dialysis or preemptive kidney transplantation (48% were of Jewish ethnicity, 45% of Arab ethnicity and 4% of Druze ethnicity). Patient data were derived from the Israeli kidney failure registry between Jan. 1, 1990, and April 1, 2020.
Researchers conducted statistical analysis with the incidence rate adjusted for age, ethnicity and calendar year. Additionally, they used the appropriate age-related general population as the denominator.
During the study period, researchers identified the highest 5-year average incidence of pediatric kidney failure was 13.5 cases per million age-related population between 1994 and 1998. This decreased to 9.1 cases per million age-related population by 2015 to 2019.
Analyses revealed that Arab and Druze children showed higher kidney failure incidence rates than Jewish children (18.3, 19.4 and 7 cases per million age-related population, respectively). These rates are also higher than those of most Western countries, according to the study.
Researchers identified the most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract, were cystic kidney diseases among Arab children and were glomerulonephritis among Jewish children. Moreover, the most common etiology among Druze children was primary hyperoxaluria type 1.
Jewish children showed higher rates of kidney transplantation than children of other groups studied during the entire study period. However, wait time for cadaveric transplantation was the same among all ethnic groups studied.
“In conclusion, our study demonstrates that the Arab and Druze pediatric kidney failure populations differ from the Jewish population in terms of incidence, etiology, treatment modalities and outcomes,” Regev-Epstein and colleagues wrote. “Exceptionally high incidence rate, low rates of living donor transplantations and an overall worse prognosis of minorities call for a special attention for this group of patients in order to improve their outcomes. Understanding the factors leading to high incidence of kidney diseases and low living donor transplantations rates may help develop intervention programs that will address both issues.”
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