Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study.
BACKGROUND
To establish mortality rates, causes of death, and determinants of mortality in children with end-stage renal disease (ESRD), we performed a national long-term follow up study.


METHODS
Mortality rate was determined in all Dutch patients with onset of ESRD at ages 0 to 14 years in the period between 1972 and 1992. Causes of death and mortality determinants were investigated in all patients of this cohort who were born before 1979. Data were derived from the Dutch Registry for patients on renal replacement therapy (RRT), medical charts and National Health Database.


RESULTS
Of all 381 patients 85 had died. The overall mortality rate (MR) was 1.57/100 patient-years, and the standardized mortality rate (SMR) was 31.0. The MR for patients 0 to 5 and 6 to 10 years old at onset of ESRD decreased from, respectively, 7.0 (range 0-14.9) to 3.9 (1.2-6.7) and 4.3 (1.1-7.5) to 1.6 (0.3-2.8) between the periods 1972-1981 and 1982-1992. The mortality hazard ratio of relatively long standing dialysis and of long standing hypertension were, respectively, 7.2 (4.4-11.8) and 3.1 (2.1-4.6), of cyclosporine-introduction in transplanted patients 0.3 (0.1-0.4). Overall cerebrovascular accidents (24%) and infections (21%) were the most common causes of death; after 10 years of RRT cardiac death (7/21) was most prevalent. Cardiovascular death was most prominent in dialysis as well as transplanted patients.


CONCLUSIONS
Survival in children with ESRD has increased over the last 20 years, but the SMR remains high. Early transplantation and a more vigorous approach toward hypertension and infection may be mandatory in order to further reduce mortality.
Groothoff
Jaap W
JW
Department of Pediatric Nephrology, and Department of Pediatrics, Emma Children's Hospital AMC, Amsterdam; Department of Pediatric Nephrology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. j.w.groothoff@amc.uva.nl
Gruppen
Mariken P
MP
Offringa
Martin
M
Hutten
Jeroen
J
Lilien
Marc R
MR
Van De Kar
Nicole J
NJ
Wolff
Eric D
ED
Davin
Jean Claude
JC
Heymans
Hugo S A
HS
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors