title: Hemodialysis outcomes in a global sample of children and young adult hemodialysis patients: the PICCOLO MONDO cohort.
abstract: BACKGROUND
  The aim of this study was to describe the experience of pediatric and young adult hemodialysis (HD) patients from a global cohort.
  
  
  METHODS
  The Pediatric Investigation and Close Collaborative Consortium for Ongoing Life Outcomes for MONitoring Dialysis Outcomes (PICCOLO MONDO) study provided de-identified electronic information of 3244 patients, ages 0-30 years from 2000 to 2012 in four regions: Asia, Europe, North America and South America. The study sample was categorized into pediatric (≤18 years old) and young adult (19-30 years old) groups based on the age at dialysis initiation.
  
  
  RESULTS
  For those with known end-stage renal disease etiology, glomerular disease was the most common diagnosis in children and young adults. Using Europe as a reference group, North America [odds ratio (OR) 2.69; CI 1.29, 5.63] and South America (OR 4.21; CI 2.32, 7.63) had the greatest mortality among young adults. North America also had higher rates of overweight, obesity, hypertension, cardiovascular disease, hospitalizations and secondary diabetes compared with all other regions. Initial catheter use was greater for North American (86.4% in pediatric patients and 75.2% in young adults) and South America (80.6% in pediatric patients and 75.9% in young adults). Catheter use at 1-year follow-up was most common in North American children (77.3%) and young adults (62.9%). Asia had the lowest rate of catheter use. For both age groups, dialysis adequacy (equilibrated Kt/V) ranged between 1.4 and 1.5. In Asia, patients in both age groups had significantly longer treatment times than in any other region.
  
  
  CONCLUSIONS
  The PICCOLO MONDO study has provided unique baseline and 1-year follow-up information on children and young adults receiving HD around the globe. This cohort has brought to light aspects of care in these age groups that warrant further investigation.
authors.affiliation: University of North Carolina at Chapel Hill Kidney Center , Chapel Hill, NC , USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Ferris
authors.affiliation: University of North Carolina at Chapel Hill Kidney Center , Chapel Hill, NC , USA.
authors.forename: Keisha
authors.initials: K
authors.lastname: Gibson
authors.affiliation: University of Michigan at Ann Arbor , Ann Arbor, MI , USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Plattner
authors.affiliation: University of Michigan at Ann Arbor , Ann Arbor, MI , USA.
authors.forename: Debbie S
authors.initials: DS
authors.lastname: Gipson
authors.affiliation: Renal Research Institute, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany; Danube University, Krems, Austria.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Fresenius Latin America , Buenos Aires , Argentina.
authors.forename: Cristina
authors.initials: C
authors.lastname: Marelli
authors.affiliation: Fresenius Medical Care Asia Pacific , Hong Kong , China.
authors.forename: Michael
authors.initials: M
authors.lastname: Etter
authors.affiliation: Fresenius Medical Care , Bad Homburg , Germany.
authors.forename: Paola
authors.initials: P
authors.lastname: Carioni
authors.affiliation: Kuratorium für Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; University of Cologne Medical Center, Cologne, Germany.
authors.forename: Gero
authors.initials: G
authors.lastname: von Gersdorff
authors.affiliation: Fresenius Medical Care Asia Pacific , Hong Kong , China.
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Xu
authors.affiliation: Maastricht University Medical Center , Maastricht , The Netherlands.
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.affiliation: Renal Research Institute , New York, NY , USA.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Xiao
authors.affiliation: Maastricht University Medical Center , Maastricht , The Netherlands.
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.affiliation: Bristol School of Medicine , Bristol , UK.
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.affiliation: PUCPR , Curitiba , Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Picoits-Filho
authors.affiliation: PUCPR , Curitiba , Brazil.
authors.forename: Lucimary
authors.initials: L
authors.lastname: Sylvestre
authors.affiliation: University of North Carolina at Chapel Hill Kidney Center , Chapel Hill, NC , USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Westreich
authors.affiliation: Renal Research Institute, New York, NY, USA; Fresenius Medical Care North America, Waltham, MA, USA.
authors.forename: Len
authors.initials: L
authors.lastname: Usvyat
keywords: adolescents; international; young adults