OBJECTIVES: Chronic kidney disease (CKD) is the focus of national policy efforts worldwide. Children and adolescents with CKD are at very high risk for developing end-stage renal disease (ESRD), and of cardiovascular related mortality during young adulthood. Decision makers should account for multiple interventions to manage modifiable risk of ESRD and delay deterioration of renal dysfunction. The aims of this study were to predict the renal failure timeframe of childhood onset CKD and its clinical burden to the health care system using population-based national health insurance claims database in Taiwan. METHODS: This study used 14-year claims data of newly-diagnosed CKD in the national pediatric cohort (<20 years). ESRD defined as need for chronic dialysis or kidney transplantation (renal replacement therapies, RRT). Development and validation of prediction model used to predict ESRD included demographic, baseline risks, CKD complications with or without medication therapy, and congenital anomalies of kidney and urinary tract (CAKUT) or non-CAKUT of CKD. Models were developed using Cox models and evaluated using C statistics and Akaike Information Criteria for goodness of fit.   RESULTS: The study cohort included 51,846 pedistric patients (CAKUT:28.9%, non-CAKUT: 71.1%). Incidence of RRT was 2.26% and 0.95% for mortality. The most accurate model for RRT: age, CAKUT/non-CAKUT, prior diabetes, cancer, nutritional deficiency, mineral and metabolic disorders, anemia, hypertension-related cardiovascular disease, growth failure (C statistic, 0.917; 95% CI, 0.901-0.933 in the development cohort and 0.841; 95% CI, 0.825-0.857 in the validation cohort). In the validation cohort, model was more accurate than a simpler model that included age, development of CKD-related complications. CONCLUSIONS: Taiwan's  ESRD incidence in young adulhood compared to world rates is high. Despite uncertainty of CKD stage, this model projects a comparative risk of indivudial complication to increasing ESRD. Our example provides valid childhood CKD model to inform clinical and policy decisions improving pediatric CKD care.