Objective: To analyze diagnosis rate of chronic kidney disease (CKD) in hospitalized pediatric patients in a single center and understand pediatricians' awareness of CKD. Methods: This was a cross-sectional study. Children who were admitted to the Division of Pediatric Nephrology, Peking University First Hospital from January 1, 2008 to December 31, 2017 and met the diagnostic criteria of CKD (kidney disease: improving global outcomes 2012 guideline) were recruited. A total of 4 472 cases were enrolled. Original CKD diagnosis was collected from the home page of medical records. Actual CKD diagnosis was validated and corrected by reviewing medical records and recalculating glomerular filtration rate. The diagnosis rate and influencing factors of pediatric CKD, the distribution and etiology of actual CKD were analyzed. The comparison between groups were performed with χ(2) test. Results: In 4 472 cases, there were 3 470 cases in actual CKD stage 1, among which only 24 cases were in original CKD stage 1. There were 543 cases in actual CKD stage 2-3, among which only 181 cases were in original CKD stage 2-3. Three hundred and one cases were in actual CKD stage 4-5, including 290 cases in original CKD stage 4-5. In addition, there were 43 cases with unknown CKD stage and 115 cases with acute kidney injury. Compared to original CKD diagnosis, the diagnosis rates of CKD stage 1-5 were 0.7% (24/3 470), 16.7% (58/348), 63.1% (123/195), 90.7% (78/86) and 98.6% (212/215), respectively. The proportions of actual CKD stage 1-5 were 80.4% (3 470/4 314), 8.1% (348/4 314), 4.5% (195/4 314), 2.0% (86/4 314) and 5.0% (215/4 314). The etiology of actual CKD included primary glomerular disease (62.2%, 2 686/4 314), secondary glomerular disease (19.7%, 849/4 314), hereditary kidney disease (9.1%, 391/4 314), congenital abnormalities of the kidney and urinary tract (CAKUT) (3.1%, 135/4 314), tubulointerstitial disease (2.2%, 94/4 314) and etiology uncertain (2.1%, 89/4 314). The leading cause of end stage renal disease was etiology uncertain (31.1%, 67/215), followed by hereditary kidney disease (24.2%, 52/215), CAKUT (16.3%, 35/215) and primary glomerular disease (16.3%, 35/215). Conclusions: Among actual CKD hospitalized pediatric patients, the diagnosis rate of CKD given by physicians at discharge was relatively low, especially patients in earlier CKD stages, which reflected serious lack of physicians' awareness of CKD.
目的： 分析住院患儿慢性肾脏病（CKD）诊断率，从而反映儿科医师对CKD的诊断意识。 方法： 采用横断面研究，纳入2008年1月1日至2017年12月31日在北京大学第一医院儿科肾脏病房住院治疗的且通过逐一阅读病历判断符合改善全球肾脏病预后组织2012年CKD诊断标准的4 472例病例。通过病案首页获得原始CKD诊断和分期。通过逐一阅读病历、重新计算肾小球滤过率、验证并纠正原始CKD诊断和分期，从而获得实际CKD诊断和分期。统计儿童CKD诊断率及影响因素，实际CKD诊断和分期的人数分布和病因构成。组间比较采用χ(2)检验。 结果： 4 472例病例中，实际CKD 1期共3 470例，其中原始CKD 1期仅24例；实际CKD 2~3期共543例，其中原始CKD 2~3期仅181例；实际CKD 4~5期共301例，其中原始CKD 4~5期共290例。此外，CKD分期不明共43例，急性肾损伤共115例。与原始CKD诊断和分期相比，实际CKD 1~5期诊断率分别为0.7%（24/3 470）、16.7%（58/348）、63.1%（123/195）、90.7%（78/86）和98.6%（212/215）。实际CKD 1~5期病例分别占80.4%（3 470/4 314）、8.1%（348/4 314）、4.5%（195/4 314）、2.0%（86/4 314）和5.0%（215/4 314）。原发性肾小球疾病占62.2%（2 686/4 314）、继发性肾小球疾病占19.7%（849/4 314）、遗传性肾脏病占9.1%（391/4 314），先天性肾脏和尿道畸形占3.1%（135/4 314），肾小管及肾间质疾病占2.2%（94/4 314），病因不明占2.1%（89/4 314）。终末期肾脏病（ESRD）病因以病因不明为主（31.1%，67/215），其次为遗传性肾脏病（24.2%，52/215）、先天性肾脏和尿道畸形（16.3%，35/215）和原发性肾小球疾病（16.3%，35/215）。 结论： 在单中心住院的实际CKD患儿中，出院时临床医师给予CKD诊断的比例较低，尤其是在早期CKD患儿中。这反映临床医师对儿童CKD的诊断意识严重不足。.
Keywords: Child; Early diagnosis; Kidney failure, chronic.