Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period.
End-stage renal disease requiring renal replacement therapy (RRT) during the neonatal period is a very rare condition, and little information is available regarding long-term RRT and outcomes. To gain more information, we performed a collaborative study on patient characteristics and treatment outcomes in children who started RRT as neonates during their first month of life between 2000 and 2011 who were prospectively registered in the ESPN/ERA-EDTA, the IPPN (since 2007), the Japanese registry, or the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry. During the first month of life, 264 patients from 32 countries started RRT and were followed for a median of 29 months (interquartile range 11-60 months). Most neonates (242) started on peritoneal dialysis, 21 started on hemodialysis, and 1 patient with a transplant. The most important causes of renal failure were congenital anomalies of the kidney and urinary tract in 141, cystic kidneys in 35, and cortical necrosis in 30. Within 2 years after the start of RRT, 69 children changed dialysis modality and 53 received a renal transplant. After a median of 7 months, 45 children had died, mainly because of infection, resulting in an estimated 2-year survival of 81%, and 5-year survival of 76%. Growth retardation (63%), anemia (55%), and hypertension (57%) were still major problems after 2 years. Thus, relatively good medium-term patient survival may be achieved with RRT started during the neonatal period, but specific therapeutic challenges continue to exist in this age group.
ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, The Netherlands.
Kariljn J
KJ
van Stralen
1] Department for Pediatric Nephrology and Hypertension, Medical University of Gdansk, Gdansk Poland [2] Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
Dagmara
D
Borzych-Dużalka
Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Hiroshi
H
Hataya
School of Women's & Children's Health, University of New South Wales, UNSW Medicine, Sydney, NSW, Australia.
Sean E
SE
Kennedy
ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, The Netherlands.
Kitty J
KJ
Jager
Istituto Giannina Gaslini, Genoa, Italy.
Enrico
E
Verrina
Bristol Royal Hospital for Children, Bristol, UK.
Carol
C
Inward
Children's Hospital University of Helsinki, Helsinki, Finland.
Kai
K
Rönnholm
University Hospital Prague-Motol, Prague, Czech Republic.
Karel
K
Vondrak
Children's Mercy Hospital, Kansas City, Missouri, USA.
Bradley A
BA
Warady
Department for Pediatric Nephrology and Hypertension, Medical University of Gdansk, Gdansk Poland.
Aleksandra M
AM
Zurowska
Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
Franz
F
Schaefer
Centre de référence des maladies rénales rares, Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France.
Pierre
P
Cochat
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome