Chronic Renal Failure in Jamaican Children : 2007-2012

Research Article

Chronic Dis Int. 2016; 3(1): 1024.

Chronic Renal Failure in Jamaican Children : 2007-2012

Miller MEY¹* and Williams JA²

¹Department of Child and Adolescent Health, University of the West Indies, Jamaica

²The Bustamante Hospital for Children, Jamaica

*Corresponding author: Miller MEY, Department of Child and Adolescent Health, University of the West Indies, Mona, Kingston 7, Jamaica

Received: August 29, 2016; Accepted: October 16, 2016; Published: October 18, 2016


This retrospective review documents the incidence, epidemiology, etiology and outcome of chronic renal failure in Jamaican children under age 12 years between 2007-2012.The required data were obtained from the medical records of Jamaica’s only two pediatric nephrology centres and by telephone review from pediatricians in rural hospitals. Twenty seven children (63% male) developed chronic renal failure between 2007-2012. The cumulative annual incidence per million child population < age 12 years was 7.83 and per million population 1.67. The average age at diagnosis of renal disease was 4.1 years (range birth - 10.5 years). The mean age at diagnosis of chronic renal failure was 4.39 years (range birth - 10.2 years). No child presented for the first time in end stage renal disease. Congenital urological disease (posterior urethral valves and renal dysplasia) was the commonest cause of chronic renal failure (48%), followed by glomerulonephritis (35%) only 2 cases of which were post infections (HIV and Dengue). Of 11 children progressing to end stage renal failure during this period, all 9 who were eligible received dialysis. Two children with severe comorbidities were excluded and died (end stage renal disease mortality of 7.4%). The incidence of chronic renal failure in Jamaican children continues to rise. Early diagnosis is usual. Posterior urethral valves contribute significantly to chronic renal failure. Chronic dialysis is now available to all eligible children. Our goal should now be renal transplantation.

Keywords: Chronic renal failure; Jamaican children; Glomerulonephritis; Posterior urethral valves; Dialysis


CRF: Chronic Renal Failure; UTI: Urinary Tract Infections; CKD: Chronic Kidney Disease; PMARP: Per Million Age Related Population; PUV: Posterior Urethral Valves; VUR: Vesico-Ureteric Reflux; HIV: Human Immunodeficiency Virus; ESRD: End Stage Renal Disease; GFR: Glomerular Filtration Rate


Jamaica is an island in the Western Caribbean with an estimated population in 2012 of 2.71 million of whom 19% are children under that age of 12 years [1]. Paediatric nephrology was introduced as a subspecialty in December 1984 and since then regular reviews of the incidence of CRF in children < age 12 years have been done. From 1985 to 2006 CRF data have shown both a shift in the aetiology of disease from acquired to congenital lesions as well as an increase in incidence [2,3]. In the 16 year period between 1985-2000 the cumulative annual incidence of CRF in Jamaican children was 3.2/ million child population < age 12 years compared with 4.1 in the 6 year period 2001- 2006 [2,3]. The incidence of CRF in Nigeria between 1985 -2000 was similar to ours at that time, with the same aetiological distribution [4]. However over the two periods of study, there has been, in Jamaica, a reduction in glomerular disease from 50% to 33.3% with congenital urological pathology predominating in the later review at 44.5% [3]. This is the pattern in developed countries such as North America [5]. On the other hand, glomerular disease still predominates in the current Nigerian literature [6,7].

Antenatal ultrasounds and prompt radiological investigation of first paediatric UTI are now more commonplace in Jamaica since the introduction of local protocols so earlier diagnosis of congenital urological abnormalities is possible.

In the developing world, dialysis for children is not universally available. Accessibility is limited by affordability [4,8]. Over last few years, more children in Jamaica have benefited from dialysis [3]. As more paediatricians become posted to additional rural parishes it is expected that there will be earlier recognition and diagnosis of CKD locally.

With better management, more children with CKD survive for longer periods and the illness poses a financial burden both to the individual as well as the country. There is a need for medication, dialysis and eventually transplantation. It is therefore crucial that there be current statistics to enable strategic intervention to prevent additional cases if preventable causes are identified. Additionally knowledge of the extent of the problem allows successive governments to predict and budget for the additional expenses and services that will be required to cope with the disease. The present retrospective study aims to address these issues by documenting all new cases of CRF in Jamaican children < age 12 years between 2007-12, providing current data about the incidence and causes of paediatric chronic renal failure locally and dialysis availability.

Patients and Methods

Jamaica is divided into 14 administrative regions (parishes). The business hub is in the parishes of Kingston and St. Andrew and it is here that the island’s two paediatric nephrology centres are located. All children islandwide with CRF are referred to paediatric renal centres at either the Bustamante Hospital for Children and the University Hospital of the West Indies.

Data on all Jamaican children under the age of 12 years diagnosed for the first time with CRF between 2007 - 2012 were identified by medical records search at the University Hospital of the West Indies and the Bustamante Hospital for Children and by telephone interview to paediatricians across the island to discover any children who had not yet been referred.

The cause and age at diagnosis of CRF, interval between diagnosis of renal disease and onset of CRF, sex, parish of origin, as well as access to renal replacement therapy and outcome (death or survival) were documented. Chronic renal failure was defined as CKD stage >3 (GFR <60ml/min/1.73m2) for least 3 months [9] or for <3 months if at diagnosis there were features of chronicity (anemia, bone disease) at presentation or SEVERE irreversible urological malformations [2]. GFR was calculated using the Schwartz formula [10]. As K/ DOQI guidelines for CKD staging do not apply to children < age 2 years, CRF in this age group was defined as estimated GFR < 25% of normal for age.

The annualized incidence PMARP < age 12 and per total population were calculated using the end year population statistics while the cumulative annual incidence PMARP < age 12 years and per million population were derived from the end of year population estimates for the mid study year (2009). Population statistics were based on the 2011 census [1].

Ethical approval was obtained from the SERAH (South East Regional Health Authority) and University of the West Indies/ University Hospital of the West Indies Ethics Committee.


Between 2007 and 2012 twenty seven new children were diagnosed with chronic renal failure. There were 17 males with a male:female ratio of 1.7:1. The cumulative annual incidence PMARP < age 12 years was 7.83, and the cumulative annual incidence/million population 1.67. The mean annualized incidence PMARP was 8.3 and per million population 1.66. Most (68%) of the 25 children in whom the parish of origin was known, came from parishes on the south coast in or near Kingston and St. Andrew (Figure 1). There were no cases of CRF from St. Elizabeth, Trelawny and Portland.