Children With Spina Bifida May Have Increased Risk of CKD and End-Stage Renal Disease: JAMA
Canada: Researchers have found in a new cohort study that pediatric patients with spina bifida have a significantly increased risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD), with disease onset occurring approximately 5 to 7 years earlier than in the general population. Several clinical factors were identified as being associated with progressive kidney decline.
These findings highlight the need for early multidisciplinary pediatric care and regular renal surveillance to detect and manage kidney complications in children with spina bifida.
Published in JAMA Network Open, the cohort study by Hannah S. Thomas of the Division of Urology, University of Toronto, Toronto, Ontario, Canada, and colleagues evaluated the long-term risk, age at onset, and predictors of kidney disease in pediatric patients with spina bifida.
The researchers analyzed population-based health administrative data from Ontario, Canada, including all publicly insured individuals born between April 1992 and March 2023. A total of 4,380,749 individuals were included, comprising 12,868 patients with spina bifida and the general population as controls. Participants were followed for a median of 15 years, and the incidence of chronic kidney disease (CKD), end-stage renal disease (ESRD), and clinical factors associated with CKD were assessed.
Key findings
- The incidence of chronic kidney disease was 2.7 per 1,000 person-years among patients with spina bifida, compared with 0.3 per 1,000 person-years in the general population.
- The incidence of end-stage renal disease was 0.3 per 1,000 person-years in the spina bifida group versus 0.01 per 1,000 person-years among individuals without spina bifida.
- Children with spina bifida developed CKD at a median age of 5 years, compared with 10 years in the general population.
- Progression to ESRD occurred earlier in patients with spina bifida, with a median age of 8 years versus 15 years in controls.
- Factors independently associated with CKD included earlier birth year, male sex, higher comorbidity burden, diabetes, upper urinary tract stones, recurrent complex urinary tract infections, and previous urologic surgery.
The researchers noted that the use of administrative health records limited their ability to determine the direct cause of kidney disease or assess disease severity and underlying mechanisms. They also acknowledged the possibility of residual confounding due to unmeasured factors.
Overall, the findings indicate that children with spina bifida are at a markedly higher and earlier risk of CKD and ESRD than the general population. The authors highlight the need for early multidisciplinary care, regular renal surveillance, and prompt management of risk factors to help prevent kidney complications and improve long-term outcomes.
Reference:
Thomas HS, Matta R, Morais S, et al. Kidney Morbidity in Pediatric Patients With Spina Bifida. JAMA Netw Open. 2026;9(6):e2619794. doi:10.1001/jamanetworkopen.2026.19794
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