title: Infants Requiring Maintenance Dialysis: Outcomes of Hemodialysis and Peritoneal Dialysis.
abstract: BACKGROUND
  The impact of different dialysis modalities on clinical outcomes has not been explored in young infants with chronic kidney failure.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Data were extracted from the ESPN/ERA-EDTA Registry. This analysis included 1,063 infants 12 months or younger who initiated dialysis therapy in 1991 to 2013.
  
  
  METHODS
  Type of dialysis modality.
  
  
  METHODS
  Differences between infants treated with peritoneal dialysis (PD) or hemodialysis (HD) in patient survival, technique survival, and access to kidney transplantation were examined using Cox regression analysis while adjusting for age at dialysis therapy initiation, sex, underlying kidney disease, and country of residence.
  
  
  RESULTS
  917 infants initiated dialysis therapy on PD, and 146, on HD. Median age at dialysis therapy initiation was 4.5 (IQR, 0.7-7.9) months, and median body weight was 5.7 (IQR, 3.7-7.5) kg. Although the groups were homogeneous regarding age and sex, infants treated with PD more often had congenital anomalies of the kidney and urinary tract (CAKUT; 48% vs 27%), whereas those on HD therapy more frequently had metabolic disorders (12% vs 4%). Risk factors for death were younger age at dialysis therapy initiation (HR per each 1-month later initiation, 0.95; 95% CI, 0.90-0.97) and non-CAKUT cause of chronic kidney failure (HR, 1.49; 95% CI, 1.08-2.04). Mortality risk and likelihood of transplantation were equal in PD and HD patients, whereas HD patients had a higher risk for changing dialysis treatment (adjusted HR, 1.64; 95% CI, 1.17-2.31).
  
  
  CONCLUSIONS
  Inability to control for unmeasured confounders not included in the Registry database and missing data (ie, comorbid conditions). Low statistical power because of relatively small number of participants.
  
  
  CONCLUSIONS
  Despite a widespread preconception that HD should be reserved for cases in which PD is not feasible, in Europe, we found 1 in 8 infants in need of maintenance dialysis to be initiated on HD therapy. Patient characteristics at dialysis therapy initiation, prospective survival, and time to transplantation were very similar for infants initiated on PD or HD therapy.
authors.affiliation: Department of Women's and Children's Health, University-Hospital of Padova, Padova, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vidal
authors.affiliation: ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: van Stralen
authors.affiliation: ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Chesnaye
authors.affiliation: ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.bonthuis@amc.uva.nl.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Bonthuis
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Christer
authors.initials: C
authors.lastname: Holmberg
authors.affiliation: Department of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zurowska
authors.affiliation: Dialysis Unit, IRCCS Giannina Gaslini, Genoa, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Trivelli
authors.affiliation: Departamento da Criança e da Família, Hospital de Santa Maria, Lisboa, Portugal.
authors.forename: José Eduardo Esteves
authors.initials: JEE
authors.lastname: Da Silva
authors.affiliation: Karolinska Institutet-Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Herthelius
authors.affiliation: Queen Fabiola Children's University Hospital, Brussels, Belgium.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Adams
authors.affiliation: Department of Pediatrics, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Anna
authors.initials: A
authors.lastname: Bjerre
authors.affiliation: Vilnius University, Center for Pediatrics, Vilnius, Lithuania.
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.affiliation: University Hospital for Active Treatment of Pediatric Diseases, Sofia Medical University, Sofia, Bulgaria.
authors.forename: Polina
authors.initials: P
authors.lastname: Miteva
authors.affiliation: Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Khadizha
authors.initials: K
authors.lastname: Emirova
authors.affiliation: Department of Pediatric Nephrology, Çukurova University, Adana, Turkey.
authors.forename: Aysun K
authors.initials: AK
authors.lastname: Bayazit
authors.affiliation: Medical University Graz, Graz, Austria.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Mache
authors.affiliation: Hospital Infantil Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez-Moreno
authors.affiliation: Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Harambat
authors.affiliation: Departmnent of Pediatric Nephrology, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.affiliation: ESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, the Netherlands; ERA-EDTA Registry, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
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: Dialysis Unit, IRCCS Giannina Gaslini, Genoa, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
mesh_terms: D000367:Age Factors; D002423:Cause of Death; D005060:Europe; D005260:Female; D005921:Glomerulonephritis / Q000150:complications; D006297:Health Services Accessibility; D006463:Hemolytic-Uremic Syndrome / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000150:complications; D052177:Kidney Diseases, Cystic / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D009026:Mortality; D010530:Peritoneal Dialysis / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000150:complications; D014657:Vasculitis / Q000150:complications
keywords: ESPN/ERA-EDTA Registry; European Registery for Children on Renal Replacement Therapy; Pediatric nephrology; RRT modality; end-stage renal disease (ESRD); hemodialysis (HD); infant; maintenance dialysis; outcome; peritoneal dialysis (PD); renal replacement therapy (RRT); survival