Our results

So far the 4C Study helped us to improve current knowledge on the development, progression and complications of chronic kidney disease in children. The study has provided unique insights into the development of heart and vessel disease in various groups of children with chronic kidney disease.
In addition, the data and biosamples collected during the study allows to study a large number of genetic, clinical and laboratory factors associated with chronic kidney disease progression that may help to identify children at risk of rapid loss of kidney function.


These are some of the important findings that were revealed in the 4C Study so far:


  • Thickening of the heart muscle (left ventricular hypertrophy) and the large arteries (increased intima media thickness) were present in more than half of the patients at the start of the study, and developed in further patients in the course of the study as kidney function declined. In many of the affected patients these abnormalities went along with impaired contraction of the heart muscle and stiffening of the large arteries. Blood pressure appears to be single most important factor contributing to early cardiovascular damage.

  • Patients who undergo kidney transplantation benefit from an early favorable reversal of vessel abnormalities compared to patients who start dialysis.

  • Two thirds of the patients in our study were vitamin D deficient. Low levels of vitamin D were more common in girls, patients with glomerular diseases (such as nephrotic syndrome or vasculitis) and patients with proteinuria.

  • Metabolic acidosis, a common complication due to urinary loss of bicarbonates, was found to be associated with faster kidney function decline in children. This suggests that consequent correction of acidosis with sodium bicarbonate may help to better preserve kidney function.

  • Two potential biomarkers that allow to improve the prediction of renal function decline were identified for the first time in children with CKD: suPAR (tested in blood) and uEGF (tested in urine).

Our publications