Abstract
BackgroundData on long-term outcomes in children who have received renal replacement therapy (RRT) for end-stage renal disease are limited.MethodsWe studied long-term survival and incidence of fatal and nonfatal cardiovascular disease (CVD) events and determinants of these outcomes in children who initiated RRT between 1961 and 2013 using data from the Scottish Renal Registry (SRR). Linkage to morbidity records was available from 1981.ResultsA total of 477 children of whom 55% were boys, almost 50% had congenital urinary tract disease (CAKUT), 10% received a transplant as the first mode of RRT and almost 60% were over 11 years of age at start of RRT were followed for a median of 17.8 years (interquartile range (IQR) 8.7–26.6 years). Survival was 87.3% (95% confidence interval (CI) 84.0–90.1) at 10 years and 77.6% (95% CI 73.3–81.7) at 20 years. During a median follow-up of 14.96 years (IQR 7.1–22.9), 20.9% of the 381 patients with morbidity data available had an incident of CVD event. Age < 2 years at start of RRT, receiving dialysis rather than a kidney transplant and primary renal disease (PRD) other than CAKUT or glomerulonephritis (GN), were associated with a higher risk of all-cause mortality. Male sex, receiving dialysis rather than a kidney transplant and PRD other than CAKUT or GN, was associated with a higher risk of CVD incidence.ConclusionsMortality and CVD incidence among children receiving RRT are high. PRD and RRT modality were associated with increased risk of both all-cause mortality and CVD incidence.
Highlights
End-stage renal disease (ESRD) in children is rare with median global incidence of renal replacement therapy (RRT) estimated to be nine children per million aged 4–18 years in 2008 [1]
The characteristics of both cohorts show that the proportion of boys was higher than girls and the majority of the patients started RRT when they were older than 12 years of age
Median follow-up time was longest for patients starting RRT on HD (21.5 year), followed by peritoneal dialysis (PD) (17.2 years), and pre-emptive transplant patients had the shortest median follow-up time of 14.2 years
Summary
End-stage renal disease (ESRD) in children is rare with median global incidence of renal replacement therapy (RRT) estimated to be nine children per million aged 4–18 years in 2008 [1] It is a serious healthcare problem requiring RRT in the form of dialysis or kidney transplantation to sustain life [2]. Methods We studied long-term survival and incidence of fatal and nonfatal cardiovascular disease (CVD) events and determinants of these outcomes in children who initiated RRT between 1961 and 2013 using data from the Scottish Renal Registry (SRR). Age < 2 years at start of RRT, receiving dialysis rather than a kidney transplant and primary renal disease (PRD) other than CAKUT or glomerulonephritis (GN), were associated with a higher risk of all-cause mortality. Male sex, receiving dialysis rather than a kidney transplant and PRD other than CAKUT or GN, was associated with a higher risk of CVD incidence
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