title: Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study.
abstract: 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.
authors.affiliation: 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
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Mariken P
authors.initials: MP
authors.lastname: Gruppen
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hutten
authors.forename: Marc R
authors.initials: MR
authors.lastname: Lilien
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Van De Kar
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wolff
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Davin
authors.forename: Hugo S A
authors.initials: HS
authors.lastname: Heymans
mesh_terms: 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