Factors affecting the progression of chronic kidney disease secondary to congenital anomalies of the kidney and urinary tract

Background: CAKUT (congenital anomalies of the kidney and urinary tract) is the most common cause of chronic kidney disease (CKD) in children. Identifying the risk factors associated with CKD progression secondary to CAKUT is crucial for early intervention and improving prognosis. This study retrospectively evaluated modifiable and non-modifiable factors influencing CKD progression in pediatric and adolescent patients with CAKUT. Methods: Data of 87 patients with CAKUT-related CKD followed at the Pediatric Nephrology Clinic of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty were analyzed retrospectively. CKD progression was defined as a ≥25% decline in eGFR during follow-up. Variables were assessed using bivariate comparison, Kaplan-Meier survival analysis, univariate and multivariate Cox regression models. Results: The median follow-up duration was 7.6 years, and CKD progression was observed in 41% of patients. In univariate analysis, baseline CKD stage, 3rd year eGFR, anemia, hyperparathyroidism, acidosis, and ACE inhibitor (ACE-i) use (protective) were significantly associated with progression. However, in multivariate analysis, only ACE-i use significantly reduced the risk of CKD progression (HR: 0.39; 95% CI: 0.18–0.87). No significant associations were found for sex, age at diagnosis, CAKUT subtype, hypertension, proteinuria, or hyperuricemia. Conclusion: ACE-i therapy was the only independent factor found to slow CKD progression in patients with CAKUT-related CKD. The lack of association with other known risk factors may be due to the limited sample size, retrospective design, and differences in outcome definitions. These findings suggest a possible role of ACE-i beyond blood pressure or proteinuria control such as antiinflammation, antioxidative and antifibrotic features, in CAKUT patients. Larger prospective studies are needed to confirm these results. Keywords: CAKUT, CKD progression, risk factors, ACE inhibitors