Mortality trends in pediatric patients with chronic renal failure.
Mortality trends were analyzed in 441 children and adolescents with chronic renal failure (CRF) observed over a 24-year period before and after institution of renal replacement therapy (RRT). A total of 93 patients died. Overall mortality rate (MR) per 100 patient years decreased from 6.6 in 1969-1978 to 2.5 in 1979-1988 and increased slightly to 2.9 in 1989-1992. The fall involved all four modes of treatment: conservative, hemodialysis (HD), continuous peritoneal dialysis (CPD), and transplantation (TX). From 1979-1988 to 1989-1992 MR on conservative and on dialysis treatment changed only slightly and was similar on HD and CPD. An alarming rise in MR was noted after TX in 1989-1992, mainly due to malignant tumors. In 44 patients who died on conservative treatment, the reasons for non-acceptance for RRT were analyzed: in 22 multi-morbidity was the main reason, usually because of a congenital neurological disorder. Some patients died from advanced uremia or unexpected events after the decision to institute RRT. Our experience demonstrates a persistent mortality in pediatric patients with CRF, which in recent years is primarily ascribed to congenital multi-morbid conditions which make RRT unfeasible, infections on dialysis treatment, and malignancies after TX.
Reiss
U
U
Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Wingen
A M
AM
Schärer
K
K
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D007680:Kidney Neoplasms / Q000401:mortality; D016030:Kidney Transplantation; D008297:Male; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D012189:Retrospective Studies