title: Mortality risk in European children with end-stage renal disease on dialysis.
abstract: We aimed to describe survival in European pediatric dialysis patients and compare the differential mortality risk between patients starting on hemodialysis (HD) and peritoneal dialysis (PD). Data for 6473 patients under 19 years of age or younger were extracted from the European Society of Pediatric Nephrology, the European Renal Association, and European Dialysis and Transplant Association Registry for 36 countries for the years 2000 through 2013. Hazard ratios (HRs) were adjusted for age at start of dialysis, sex, primary renal disease, and country. A secondary analysis was performed on a propensity score-matched (PSM) cohort. The overall 5-year survival rate in European children starting on dialysis was 89.5% (95% confidence interval [CI] 87.7%-91.0%). The mortality rate was 28.0 deaths per 1000 patient years overall. This was highest (36.0/1000) during the first year of dialysis and in the 0- to 5-year age group (49.4/1000). Cardiovascular events (18.3%) and infections (17.0%) were the main causes of death. Children selected to start on HD had an increased mortality risk compared with those on PD (adjusted HR 1.39, 95% CI 1.06-1.82, PSM HR 1.46, 95% CI 1.06-2.00), especially during the first year of dialysis (HD/PD adjusted HR 1.70, 95% CI 1.22-2.38, PSM HR 1.79, 95% CI 1.20-2.66), when starting at older than 5 years of age (HD/PD: adjusted HR 1.58, 95% CI 1.03-2.43, PSM HR 1.87, 95% CI 1.17-2.98) and when children have been seen by a nephrologist for only a short time before starting dialysis (HD/PD adjusted HR 6.55, 95% CI 2.35-18.28, PSM HR 2.93, 95% CI 1.04-8.23). Because unmeasured case-mix differences and selection bias may explain the higher mortality risk in the HD population, these results should be interpreted with caution.
authors.affiliation: ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, the Netherlands.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Chesnaye
authors.affiliation: Division of Pediatric Nephrology, University of Heidelberg, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.affiliation: Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, the Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.affiliation: ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, the Netherlands. Electronic address: m.bonthuis@amc.uva.nl.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Bonthuis
authors.affiliation: Department of Pediatrics, Semmelweis University, Budapest, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Reusz
authors.affiliation: Department of Nephrology, University of Copenhagen, Herlev, Denmark.
authors.forename: James G
authors.initials: JG
authors.lastname: Heaf
authors.affiliation: Manchester Children's Hospital, Manchester, United Kingdom.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Lewis
authors.affiliation: University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Maurer
authors.affiliation: Faculty of Medicine, University of Belgrade, Department of Nephrology, University Children(')s Hospital, Belgrade, Serbia.
authors.forename: Dušan
authors.initials: D
authors.lastname: Paripović
authors.affiliation: Department Pediatrics, Nephrology, and Hypertension, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Zagozdzon
authors.affiliation: ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, the Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: van Stralen
authors.affiliation: ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, the Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: dialysis modality; end-stage renal disease; mortality risk factors; pediatric nephrology