Advanced chronic kidney disease in children with CAKUT: a retrospective cohort study in Senegal

Abstract Background Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of chronic kidney disease (CKD) in children worldwide. In low-resource settings, delayed diagnosis and limited access to specialized nephrological and surgical care may increase the risk of progression to advanced CKD. However, long-term data from Sub-Saharan Africa remain limited. This study aimed to describe the burden of advanced CKD and associated clinical features among children with CAKUT in Senegal. Methods We conducted a retrospective cohort study including children aged 0–16 years diagnosed with CAKUT between January 2008 and December 2023 in a tertiary referral center. CKD stages were classified according to KDIGO guidelines. Associations between clinical variables and advanced CKD (stage 4–5) were assessed using logistic regression, expressed as odds ratios (OR) with 95% confidence intervals (CI). Results A total of 194 children were included. Kidney malformations accounted for 59.3% of cases and urinary tract malformations for 38.7%. Antenatal diagnosis was documented in 7.7% of patients. Overall, 19.1% of children reached advanced CKD and 12.9% progressed to end-stage kidney disease. Urinary tract infections (UTIs) occurred in 13.9% of patients and were independently associated with advanced CKD (adjusted OR 3.02; 95% CI 1.29–7.08). Among 31 children with surgical indications, 16 (51.6%) underwent operative management. Conclusion In this 16-year cohort from Senegal, nearly 20% of children with CAKUT progressed to advanced CKD. Infection burden and limited access to timely management may contribute to kidney deterioration. Strengthening early detection and structured follow-up strategies is essential to mitigate progression in resource-limited settings.