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Puberty is associated with increased deterioration of renal function in patients with CKD: data from the ItalKid Project
  1. Gianluigi Ardissino1,
  2. Sara Testa1,
  3. Valeria Daccò1,
  4. Fabio Paglialonga1,
  5. Sara Viganò1,
  6. Cristina Felice-Civitillo1,
  7. Francesco Battaglino2,
  8. Alberto Bettinelli3,
  9. Andrea Bordugo4,
  10. Valeria Cecchetti5,
  11. Salvatore De Pascale6,
  12. Angela La Manna7,
  13. Salvatore Li Volti8,
  14. Silvio Maringhini9,
  15. Giovanni Montini10,
  16. Marco Pennesi11,
  17. Leopoldo Peratoner4
  1. 1Unit of Pediatric Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  2. 2Department of Pediatric Surgery, Ospedale S. Bortolo, Vicenza, Italy
  3. 3Department of Pediatrics, Ospedale San Leopoldo Mandic, Merate, Italy
  4. 4Department of Pediatrics, Ospedale S. Maria degli Angeli, Pordenone, Italy
  5. 5Department of Neonatology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  6. 6Department of Pediatric Surgery, Ospedali Riuniti di Bergamo, Bergamo, Italy
  7. 7Department of Pediatrics, II Università di Napoli, Naples, Italy
  8. 8Department of Pediatrics, Università di Catania, Catania, Italy
  9. 9Unit of Pediatric Nephrology, Osp. dei Bambini “G. Di Cristina”, Palermo, Italy
  10. 10Unit of Pediatric Nephrology, Azienda Ospedaliera-Universitaria S. Orsola Malpighi, Bologna, Italy
  11. 11Department of Pediatrics, Ospedale Burlo Garofalo, Trieste, Italy
  1. Correspondence to Dr Sara Testa, Department of Pediatrics, Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, v. Commenda, 9, Milano 20122, Italy; saratesta{at}


Objective To analyse the timing of end stage renal disease in children with chronic kidney disease (CKD).

Design A population-based cohort study.

Setting A nationwide registry (ItalKid Project) collecting information on all patients with CKD aged <20 years.

Patients 935 children with CKD secondary to renal hypodysplasia with or without urologic malformation. In a subgroup of patients (n=40) detailed pubertal staging was analysed in relation to CKD progression.

Main outcome measures Kidney survival (KS) was estimated using renal replacement therapy (RRT) as the end-point. Puberty was staged by identifying the pubertal growth spurt.

Results A non-linear decline in the probability of KS was observed, with a steep decrease during puberty: the probability of RRT was estimated to be 9.4% and 51.8% during the first and second decades of life, respectively. A break-point in the KS curve was identified at 11.6 and 10.9 years of age in male and female patients, respectively.

Conclusions The present analysis suggests that puberty is associated with increased deterioration of renal function in CKD. The mechanism(s) underlying this unique and specific (to children) pattern of progression have not yet been identified, but it may be that sex hormones play a role in this puberty-related progression of CKD.

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