Complications of Chronic Kidney Disease in Adolescents

  • Elaine KuEmail author
  • Jonas Kwok


There is a paucity of literature focused exclusively on adolescent-aged children with chronic kidney disease (CKD). Most of the evidence available is derived from studies encompassing the entire span of childhood and adolescence. Adolescence is a unique developmental period associated with adverse outcomes in CKD – patients are subject to multifactorial stressors stemming from developmental and physiologic changes, medical complications, and psychosocial changes. As such, it is vital for caregivers to take into account these developmental changes to ensure optimal long-term health and quality of life for adolescents with CKD.


CKD Adolescent medicine Pediatric nephrology Transitional care 


  1. 1.
    Kidney Disease: Improving Global Outcomes CWG. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. [Internet]. 2013. [Cited 2018 Feb 17]. Available from: GL.pdf.
  2. 2.
    Mian AN, Schwartz GJ. Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis. 2017;24(6):348–56.CrossRefGoogle Scholar
  3. 3.
    Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003;111(4):e382–7.CrossRefGoogle Scholar
  4. 4.
    Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol Berl Ger. 2012;27(3):363–73.CrossRefGoogle Scholar
  5. 5.
    NAPRTCS Annual Report. Boston: North American Pediatric Renal Trials and Collaborative Studies [Internet]. 2014. [Cited 2017 Oct 6]. Available from:
  6. 6.
    Andreoni KA, Forbes R, Andreoni RM, Phillips G, Stewart H, Ferris M. Age-related kidney transplant outcomes: health disparities amplified in adolescence. JAMA Intern Med. 2013;173(16):1524–32.CrossRefGoogle Scholar
  7. 7.
    McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350(26):2654–62.CrossRefGoogle Scholar
  8. 8.
    Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, et al. Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease. Clin J Am Soc Nephrol CJASN. 2011;6(9):2132–40.CrossRefGoogle Scholar
  9. 9.
    Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, et al. Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clin J Am Soc Nephrol CJASN. 2006;1(5):1006–15.CrossRefGoogle Scholar
  10. 10.
    Haffner D, Zivicnjak M. Pubertal development in children with chronic kidney disease. Pediatr Nephrol. 2017;32(6):949–64.CrossRefGoogle Scholar
  11. 11.
    Schaefer F, Seidel C, Binding A, Gasser T, Largo RH, Prader A, et al. Pubertal growth in chronic renal failure. Pediatr Res. 1990;28(1):5.CrossRefGoogle Scholar
  12. 12.
    Tainio J, Qvist E, Vehmas R, Jahnukainen K, Hölttä T, Valta H, et al. Pubertal development is normal in adolescents after renal transplantation in childhood. Transplantation. 2011;92(4):404–9.CrossRefGoogle Scholar
  13. 13.
    Wesseling-Perry K, Salusky IB. Chronic kidney disease: mineral and bone disorder in children. Semin Nephrol. 2013;33(2):169–79.CrossRefGoogle Scholar
  14. 14.
    Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;76(113):S1–130.Google Scholar
  15. 15.
    Greenbaum LA, Warady BA, Furth SL. Current advances in chronic kidney disease in children: growth, cardiovascular, and neurocognitive risk factors. Semin Nephrol. 2009;29(4):425–34.CrossRefGoogle Scholar
  16. 16.
    Ingulli EG, Mak RH. Growth in children with chronic kidney disease: role of nutrition, growth hormone, dialysis, and steroids. Curr Opin Pediatr. 2014;26(2):187–92.CrossRefGoogle Scholar
  17. 17.
    Rees L, Mak RH. Nutrition and growth in children with chronic kidney disease. Nat Rev Nephrol. 2011;7(11):615–23.CrossRefGoogle Scholar
  18. 18.
    Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D. Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol Berl Ger. 2006;21(6):793–9.CrossRefGoogle Scholar
  19. 19.
    Rodig NM, McDermott KC, Schneider MF, Hotchkiss HM, Yadin O, Seikaly MG, et al. Growth in children with chronic kidney disease: a report from the chronic kidney disease in children study. Pediatr Nephrol Berl Ger. 2014;29(10):1987–95.CrossRefGoogle Scholar
  20. 20.
    Furth SL, Hwang W, Yang C, Neu AM, Fivush BA, Powe NR. Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr Nephrol Berl Ger. 2002;17(6):450–5.CrossRefGoogle Scholar
  21. 21.
    Mahan JD, Warady BA, Committee C. Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol. 2006;21(7):917–30.CrossRefGoogle Scholar
  22. 22.
    Hodson EM, Willis NS, Craig JC. Growth hormone for children with chronic kidney disease. In: Cochrane database of systematic reviews [Internet]. Wiley; 2012. [Cited 2017 Oct 4]. Available from:
  23. 23.
    Ferris ME, Miles JA, Seamon ML. Adolescents and young adults with chronic or end-stage kidney disease. Blood Purif. 2016;41(1–3):205–10.CrossRefGoogle Scholar
  24. 24.
    Maggioli C, Stagi S. Bone modeling, remodeling, and skeletal health in children and adolescents: mineral accrual, assessment and treatment. Ann Pediatr Endocrinol Metab. 2017;22(1):1–5.CrossRefGoogle Scholar
  25. 25.
    Kumar J, McDermott K, Abraham AG, Friedman LA, Johnson VL, Kaskel FJ, et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol Berl Ger. 2016;31(1):121–9.CrossRefGoogle Scholar
  26. 26.
    Denburg MR, Kumar J, Jemielita T, Brooks ER, Skversky A, Portale AA, et al. Fracture burden and risk factors in childhood CKD: results from the CKiD cohort study. J Am Soc Nephrol JASN. 2016;27(2):543–50.CrossRefGoogle Scholar
  27. 27.
    Lilien MR, Groothoff JW. Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol. 2009;5(4):229–35.CrossRefGoogle Scholar
  28. 28.
    Mitsnefes MM. Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol JASN. 2012;23(4):578–85.CrossRefGoogle Scholar
  29. 29.
    Saland JM, Pierce CB, Mitsnefes MM, Flynn JT, Goebel J, Kupferman JC, et al. Dyslipidemia in children with chronic kidney disease: a report of the Chronic Kidney Disease in Children (CKiD) study. Kidney Int. 2010;78(11):1154–63.CrossRefGoogle Scholar
  30. 30.
    Wesseling-Perry K, Pereira RC, Tseng C-H, Elashoff R, Zaritsky JJ, Yadin O, et al. Early skeletal and biochemical alterations in pediatric chronic kidney disease. Clin J Am Soc Nephrol CJASN. 2012;7(1):146–52.CrossRefGoogle Scholar
  31. 31.
    Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002;141(2):191–7.CrossRefGoogle Scholar
  32. 32.
    Gallibois CM, Jawa NA, Noone DG. Hypertension in pediatric patients with chronic kidney disease: management challenges. Int J Nephrol Renov Dis. 2017;10:205–13.CrossRefGoogle Scholar
  33. 33.
    Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, et al. Blood pressure in children with chronic kidney disease: a report from the chronic kidney disease in children study. Hypertension. 2008;52(4):631–7.CrossRefGoogle Scholar
  34. 34.
    Mitsnefes M, Stablein D. Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis. 2005;45(2):309–15.CrossRefGoogle Scholar
  35. 35.
    Kupferman JC, Aronson Friedman L, Cox C, Flynn J, Furth S, Warady B, et al. BP control and left ventricular hypertrophy regression in children with CKD. J Am Soc Nephrol JASN. 2014;25(1):167–74.CrossRefGoogle Scholar
  36. 36.
    Kidney Disease: Improving Global Outcomes CWG. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease [Internet]. 2012. [Cited 2018 Feb 18]. Available from:
  37. 37.
    Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904.CrossRefGoogle Scholar
  38. 38.
    ESCAPE Trial Group, Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639–50.CrossRefGoogle Scholar
  39. 39.
    Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5):S112–9.CrossRefGoogle Scholar
  40. 40.
    Kavey R-EW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710–38.CrossRefGoogle Scholar
  41. 41.
    Hooper DK, Williams JC, Carle AC, Amaral S, Chand DH, Ferris ME, et al. The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest pediatric nephrology consortium study. Pediatr Nephrol Berl Ger. 2013;28(6):939–49.CrossRefGoogle Scholar
  42. 42.
    Wong CJ, Moxey-Mims M, Jerry-Fluker J, Warady BA, Furth SL. CKiD (CKD in children) prospective cohort study: a review of current findings. Am J Kidney Dis Off J Natl Kidney Found. 2012;60(6):1002–11.CrossRefGoogle Scholar
  43. 43.
    Gerson A, Hwang W, Fiorenza J, Barth K, Kaskel F, Weiss L, et al. Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis. 2004;44(6):1017–23.CrossRefGoogle Scholar
  44. 44.
    Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J. 2016;9(4):583–91.CrossRefGoogle Scholar
  45. 45.
    Gerson AC, Wentz A, Abraham AG, Mendley SR, Hooper SR, Butler RW, et al. Health-related quality of life of children with mild to moderate chronic kidney disease. Pediatrics. 2010;125(2):e349–57.CrossRefGoogle Scholar
  46. 46.
    KDIGO clinical practice guideline for anemia in chronic kidney disease. National guideline clearinghouse [Internet]. [Cited 2017 Dec 13]. Available from:
  47. 47.
    Akchurin OM, Schneider MF, Mulqueen L, Brooks ER, Langman CB, Greenbaum LA, et al. Medication adherence and growth in children with CKD. Clin J Am Soc Nephrol. 2014;9(9):1519–25.CrossRefGoogle Scholar
  48. 48.
    Gerson A, Butler R, Moxey-Mims M, Wentz A, Shinnar S, Lande MB, et al. Neurocognitive outcomes in children with chronic kidney disease: current findings and contemporary endeavors. Ment Retard Dev Disabil Res Rev. 2006;12:208–15.CrossRefGoogle Scholar
  49. 49.
    Ruebner RL, Laney N, Kim JY, Hartung EA, Hooper SR, Radcliffe J, et al. Neurocognitive dysfunction in children, adolescents, and young adults with CKD. Am J Kidney Dis. 2016;67(4):567–75.CrossRefGoogle Scholar
  50. 50.
    Lande MB, Mendley SR, Matheson MB, Shinnar S, Gerson AC, Samuels JA, et al. Association of blood pressure variability and neurocognition in children with chronic kidney disease. Pediatr Nephrol. 2016;31(11):2137–44.CrossRefGoogle Scholar
  51. 51.
    Hooper SR, Gerson AC, Butler RW, Gipson DS, Mendley SR, Lande MB, et al. Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol CJASN. 2011;6(8):1824–30.CrossRefGoogle Scholar
  52. 52.
    Mendley SR, Matheson M, Shinnar S, Lande M, Gerson AC, Butler R, et al. Duration of chronic kidney disease reduces attention and executive function in pediatric patients. Kidney Int. 2015;87(4):800–6.CrossRefGoogle Scholar
  53. 53.
    Ferris ME, Mahan JD. Pediatric chronic kidney disease and the process of health care transition. Semin Nephrol. 2009;29(4):435–44.CrossRefGoogle Scholar
  54. 54.
    Gipson DS, Duquette PJ, Icard PF, Hooper SR. The central nervous system in childhood chronic kidney disease. Pediatr Nephrol. 2007;22(10):1703–10.CrossRefGoogle Scholar
  55. 55.
    Moreira JM, Soares CMBM, Teixeira AL, Silva ACS e, Kummer AM. Anxiety, depression, resilience and quality of life in children and adolescents with pre-dialysis chronic kidney disease. Pediatr Nephrol. 2015;30(12):2153–62.CrossRefGoogle Scholar
  56. 56.
    Bartosh SM, Leverson G, Robillard D, Sollinger HW. Long-term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation. 2003;76(8):1195–200.CrossRefGoogle Scholar
  57. 57.
    Soliday E, Kool E, Lande MB. Psychosocial adjustment in children with kidney disease. J Pediatr Psychol. 2000;25(2):93–103.CrossRefGoogle Scholar
  58. 58.
    Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol. 2011;36(4):375–84.CrossRefGoogle Scholar
  59. 59.
    Tong A, Wong G, McTaggart S, Henning P, Mackie F, Carroll RP, et al. Quality of life of young adults and adolescents with chronic kidney disease. J Pediatr. 2013;163(4):1179–1185.e5.CrossRefGoogle Scholar
  60. 60.
    Marciano RC, Soares CMB, Diniz JSS, Lima EM, Silva JMP, Canhestro MR, et al. Behavioral disorders and low quality of life in children and adolescents with chronic kidney disease. Pediatr Nephrol. 2011;26(2):281–90.CrossRefGoogle Scholar
  61. 61.
    Copelovitch L, Warady BA, Furth SL. Insights from the Chronic Kidney Disease in Children (CKiD) study. Clin J Am Soc Nephrol CJASN. 2011;6(8):2047–53.CrossRefGoogle Scholar
  62. 62.
    Gerson AC, Riley A, Fivush BA, Pham N, Fiorenza J, Robertson J, et al. Assessing health status and health care utilization in adolescents with chronic kidney disease. J Am Soc Nephrol. 2005;16(5):1427–32.CrossRefGoogle Scholar
  63. 63.
    Stabouli S, Papadimitriou E, Printza N, Dotis J, Papachristou F. Sleep disorders in pediatric chronic kidney disease patients. Pediatr Nephrol. 2016;31(8):1221–9.CrossRefGoogle Scholar
  64. 64.
    Dodson JL, Cohn SE, Cox C, Hmiel PS, Wood E, Mattoo TK, et al. Urinary incontinence in the CKiD cohort and health related quality of life. J Urol. 2009;182(4 Suppl):2007–14.CrossRefGoogle Scholar
  65. 65.
    Kogon AJ, Matheson MB, Flynn JT, Gerson AC, Warady BA, Furth SL, et al. Depressive symptoms in children with chronic kidney disease. J Pediatr. 2016;168:164–70.e1.CrossRefGoogle Scholar
  66. 66.
    Medway M, Tong A, Craig JC, Kim S, Mackie F, McTaggart S, et al. Parental perspectives on the financial impact of caring for a child with CKD. Am J Kidney Dis. 2015;65(3):384–93.CrossRefGoogle Scholar
  67. 67.
    Fielding D, Brownbridge G. Factors related to psychosocial adjustment in children with end-stage renal failure. Pediatr Nephrol. 1999;13(9):766–70.CrossRefGoogle Scholar
  68. 68.
    Bates CM, Charlton JR, Ferris ME, Hildebrandt F, Hoshizaki DK, Warady BA, et al. Pediatric kidney disease: tracking onset and improving clinical outcomes. Clin J Am Soc Nephrol. 2014;9:1141–3. CJN.00860114CrossRefGoogle Scholar
  69. 69.
    Hidalgo G, Ng DK, Moxey-Mims M, Minnick ML, Blydt-Hansen T, Warady BA, et al. Income level and kidney disease severity and progression among children and adolescents with CKD: a report from the Chronic Kidney Disease in Children (CKiD) Study. Am J Kidney Dis Off J Natl Kidney Found [Internet]. 2013;62(6). [Cited 2017 Oct 4]. Available from:
  70. 70.
    Javalkar K, Fenton N, Cohen S, Ferris M. Socioecologic factors as predictors of readiness for self-management and transition, medication adherence, and health care utilization among adolescents and young adults with chronic kidney disease. Prev Chronic Dis [Internet]. 2014; 11. [Cited 2017 Oct 4]. Available from:
  71. 71.
    Fathallah-Shaykh SA, Flynn JT, Pierce CB, Abraham AG, Blydt-Hansen TD, Massengill SF, et al. Progression of pediatric CKD of nonglomerular origin in the CKiD cohort. Clin J Am Soc Nephrol CJASN. 2015;10(4):571–7.CrossRefGoogle Scholar
  72. 72.
    Zilleruelo G, Andia J, Gorman HM, Strauss J. Chronic renal failure in children: analysis of main causes and deterioration rate in 81 children. Int J Pediatr Nephrol. 1980;1(1):30–3.PubMedGoogle Scholar
  73. 73.
    Koshy SM, Hebert D, Lam K, Stukel TA, Guttmann A. Renal allograft loss during transition to adult healthcare services among pediatric renal transplant patients. Transplantation. 2009;87(11):1733–6.CrossRefGoogle Scholar
  74. 74.
    O’Donohue W. Behavioral approaches to chronic disease in adolescence: a guide to integrative care. New York, NY: Springer-Verlag; 2009. 339 p.Google Scholar
  75. 75.
    Watson AR. Problems and pitfalls of transition from paediatric to adult renal care. Pediatr Nephrol Berl Ger. 2005;20(2):113–7.CrossRefGoogle Scholar
  76. 76.
    Blydt-Hansen TD, Pierce CB, Cai Y, Samsonov D, Massengill S, Moxey-Mims M, et al. Medication treatment complexity and adherence in children with CKD. Clin J Am Soc Nephrol CJASN. 2014;9(2):247–54.CrossRefGoogle Scholar
  77. 77.
    Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics. 2011;128(1):182–200.CrossRefGoogle Scholar
  78. 78.
    Watson AR, Harden PN, Ferris ME, Kerr PG, Mahan JD, Ramzy MF. Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA). Kidney Int. 2011;80(7):704–7.CrossRefGoogle Scholar
  79. 79.
    Ferris ME, Cuttance JR, Javalkar K, Cohen SE, Phillips A, Bickford K, et al. Self-management and transition among adolescents/young adults with chronic or end-stage kidney disease. Blood Purif. 2015;39(1–3):99–104.CrossRefGoogle Scholar
  80. 80.
    Bell L. Adolescents with renal disease in an adult world: meeting the challenge of transition of care. Nephrol Dial Transplant. 2007;22(4):988–91.CrossRefGoogle Scholar
  81. 81.
    Huang JS, Gottschalk M, Pian M, Dillon L, Barajas D, Bartholomew LK. Transition to adult care: systematic assessment of adolescents with chronic illnesses and their medical teams. J Pediatr. 2011;159(6):994–998.e2.CrossRefGoogle Scholar
  82. 82.
    Ku E, Johansen KL, Portale AA, Grimes B, Hsu C. State level variations in nephrology workforce and timing and incidence of dialysis in the United States among children and adults: a retrospective cohort study. BMC Nephrol [Internet]. 2015; 16. [Cited 2017 Oct 8]. Available from:

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Authors and Affiliations

  1. 1.Department of Medicine and PediatricsUniversity of California San FranciscoSan FranciscoUSA
  2. 2.College of MedicineSUNY Downstate Medical CenterBrooklynUSA

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