Survival and transplantation outcomes of children less than 2 years of age with end-stage renal disease.
BACKGROUND
Young children with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) have traditionally experienced high rates of morbidity and mortality; however, detailed long-term follow-up data is limited.


METHODS
Using a population-based retrospective cohort with data from a national organ failure registry and administrative data from Canada's universal health care system, we analysed the outcomes of 87 children starting RRT (before age 2 years) and followed them until death or date of last contact [median follow-up 4.7 years, interquartile range (IQR) 1.4-9.8). We assessed secular trends in survival and the influence of: (1) age at start of RRT and (2) etiology of ESRD with survival and time to transplantation.


RESULTS
Patients were mostly male (69.0 %) with ESRD predominantly due to renal malformations (54.0 %). Peritoneal dialysis was the most common initial RRT (83.9 %). Fifty-seven (65.5 %) children received a renal transplant (median age at first transplant: 2.7 years, IQR 2.0-3.3). During 490 patient-years of follow-up, there were 23 (26.4 %) deaths, of which 22 occurred in patients who had not received a transplant. Mortality was greater for patients commencing dialysis between 1992 and 1999 and among the youngest children starting RRT (0-3 months). Children with ESRD secondary to renal malformations had better survival than those with ESRD due to other causes. Among the transplanted patients, all but one survived to the end of the observation period.


CONCLUSIONS
Children who start RRT before 3 months of age have a high risk of mortality. Among our paediatric patient cohort, mortality rates were much lower among children who had received a renal transplant.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. todd2@ualberta.ca
R Todd
RT
Alexander
Bethany J
BJ
Foster
Marcello A
MA
Tonelli
Andrea
A
Soo
Alberto
A
Nettel-Aguirre
Brenda R
BR
Hemmelgarn
Susan M
SM
Samuel
D000367:Age Factors; D002170:Canada; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality