Current Trend of Pediatric Renal Replacement Therapy in Japan.

Abstract

End-stage renal disease (ESRD) in children is considered a rare but serious condition. Information on the epidemiology, demographics, treatment modality at the start of renal replacement therapy (RRT), and mortality of pediatric patients with ESRD is essential for a better understanding of this disease. Additionally, international comparisons of this information on pediatric patients with ESRD may improve outcomes in these children. Here, I will provide information on epidemiological and demographic characteristics of pediatric Japanese patients with ESRD and the current trend of pediatric RRT in Japan. The Japanese Society for Pediatric Nephrology (JSPN), in collaboration with the Japanese Society for Dialysis Therapy (JSDT) and the Japanese Society for Clinical Renal Transplantation (JSCRT), conducted a cross-sectional nationwide survey in 2012 to update information on the incidence, primary renal disease, initial treatment modalities, and survival in pediatric Japanese patients with ESRD aged less than 20 years during the period 2006-2011. The average incidence of ESRD was 4.0 per million age-related populations, much lower than in other high-income countries. Congenital anomalies of the kidney and urinary tract were the most common cause of ESRD, present in 39.8% of these patients, which was similar to the data reported from USA, Europe, and Australia and New Zealand. While the previous Japanese survey in 1998 reported that only 1 patient (0.9%) underwent preemptive transplantation, the JSPN ESRD Survey 2012 found that 22.3% of patients were initially treated by preemptive transplantation. Thus, the use of preemptive transplantation as the initial treatment modality for Japanese children with ESRD is comparable to that for ESRD children in the USA, Europe, and Australia and New Zealand. The 5-year survival rate of Japanese children with ESRD who received RRT was 91.5%, which was similar to the rates observed in other high-income countries. Key Messages: The incidence of ESRD is lower in Japanese children than in children in other high-income countries. There has been a marked increase in the use of preemptive transplantation as the initial treatment modality for pediatric Japanese patients with ESRD.