Prolonged respiratory disorder predicts adverse prognosis in infants with end-stage kidney disease.
Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous.



Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality.



Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32).



Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.
Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan. sakai-tomoyuki@umin.ac.jp.
Tomoyuki
T
Sakai
Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan.
Yoshitaka
Y
Murakami
Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan.
Yusuke
Y
Okuda
Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Riku
R
Hamada
Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.
Yuko
Y
Hamasaki
Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Kenji
K
Ishikura
Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Hiroshi
H
Hataya
Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Masataka
M
Honda
D000015:Abnormalities, Multiple / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008168:Lung / Q000002:abnormalities*; D008171:Lung Diseases / Q000453:epidemiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology*
End-stage kidney disease; Infant; Peritoneal dialysis; Pulmonary hypoplasia; Survival analysis; Withholding treatment