Year-end Sale % OFF 
Abstract
BackgroundPediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT.MethodsThe cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over non-infectious HAR ratio (HARR).ResultsThe HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001).ConclusionsOur findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.
Highlights
Patients starting renal replacement therapy (RRT) during the pediatric age and surviving long term are at a much higher risk of mortality compared with healthy peers, up to 30 times greater, according to long-term outcome studies
Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe urinary tract infections (UTIs) in transplantation
Bacterial infections were defined as any positive bacterial cultures, abscesses, UTIs, sepsis, tunnel/ central venous line infections, peritoneal dialysis (PD) peritonitis, sinusitis, segmental pneumonia, bilateral pneumonia with severe disease, pneumonia successfully treated with antibiotics, Bfever with chills and antibiotic treatment.^ Infections defined as viral included all diagnoses due to a specific virus, gastroenteritis except when indicated as bacterial, and upper airway infection
Summary
Patients starting renal replacement therapy (RRT) during the pediatric age and surviving long term are at a much higher risk of mortality compared with healthy peers, up to 30 times greater, according to long-term outcome studies. By definition, these data concern historical patients who underwent a different approach compared with current practices. Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. We demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. We explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
