A multicenter experience on patient and technique survival in children on chronic dialysis.
In this study we compared patient and technique survival of 163 new hemodialysis (HD) patients (age 11.4+/-3.1 years) and 295 peritoneal dialysis patients (7.7+/-4.8 years. P< 0.001), treated in 23 dialysis centers participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) during the years 1989-2000. Three HD (1.8%) and 17 CPD (5.8%) patients died; the overall average death rate was 9.8/1,000 patient-years in HD and 29.8/1,000 patient-years in CPD patients. No statistically significant difference in patient survival between CPD and HD was found, while the survival of 102 CPD children younger than 5 years at the start of dialysis was lower ( P=0.0001) than that of 193 CPD and 160 HD patients aged 5-15 years. We registered 12 modality failures among HD (7.4%) patients and 44 among CPD (14.9%) patients. The main causes were vascular access failure and patient choice in HD, and infection in CPD patients. Technique survival was lower ( P=0.007) in CPD than in HD patients; a statistically significant difference ( P=0.01) was also observed between both the 0- to 5- and the 5- to 15-year-old CPD patients and the HD patients aged 5-15 years. Logistic regression analysis confirmed age at initiation of dialysis to be a predictor of patient death ( P=0.0001) in the whole patient population, and of technique failure in HD ( P=0.006) but not in CPD patients ( P=0.16).
Verrina
Enrico
E
Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Largo G. Gaslini 5, 16148 Genoa, Italy. nefroigg@tin.it
Edefonti
Alberto
A
Gianoglio
Bruno
B
Rinaldi
Stefano
S
Sorino
Palma
P
Zacchello
Graziella
G
Lavoratti
Giancarlo
G
Maringhini
Silvio
S
Pecoraro
Carmine
C
Calevo
Maria Grazia
MG
Turrini Dertenois
Laura
L
Perfumo
Francesco
F
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D010530:Peritoneal Dialysis / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis