Single-center analysis of etiology and complications in hospitalized children with chronic kidney disease stages 3–5

Objective To investigate the etiology spectrum and complication profiles of hospitalized children with chronic kidney disease (CKD) stages 3–5, identify independent risk factors for CKD progression, and provide evidence for optimizing early clinical management. We hypothesized that congenital anomalies of the kidney and urinary tract (CAKUT) are the predominant etiology in this cohort, and baseline eGFR decline plus uncontrolled hypertension would independently predict progression to stage 5 CKD. Methods A retrospective cohort study was conducted on 170 children with CKD stages 3–5 admitted to the Nephrology Department of Beijing Children's Hospital from January 2016 to December 2023. Etiology, complication rates, and their associations with CKD stages were analyzed. Multivariate logistic regression models were used to identify independent risk factors for progression to stage 5 CKD, adjusting for age, sex, and underlying etiology. Results CAKUT accounted for 51.8% of cases, followed by glomerular diseases (22.4%). The prevalence of anemia (80.5%), hypertension (64.1%), and CKD-MBD (90.6%) increased significantly with CKD progression ( P < 0.001 for all). Anemia occurred in 100% of stage 5 non-dialysis patients, while hypertension control rates were only 45.3%. Multivariate analysis identified baseline eGFR <30 mL/min/1.73 m² (OR = 4.2, 95% CI: 2.1–8.3, P < 0.001) and uncontrolled hypertension (OR = 2.5, 95% CI: 1.5–4.2, P = 0.001) as independent predictors of progression to stage 5 CKD. The overall infection rate was 28.2%. Conclusion CAKUT is the leading etiology of CKD stages 3–5 in hospitalized children, with a high burden of complications. Early intervention for anemia, hypertension, and CKD-MBD, combined with enhanced infection prevention, may improve clinical outcomes. Baseline eGFR <30 mL/min/1.73 m² and uncontrolled hypertension are key targets for delaying CKD progression. Notably, the distribution of etiology and complication burden in this cohort parallels patterns reported in North America and Europe, supporting the global applicability of KDIGO-based management strategies.