MO1038: Haematologic Factors Associated with Favourable Long-Term Outcomes in Paediatric Patients with Chronic Kidney Disease on Maintenance Haemodialysis

Abstract

Abstract BACKGROUND AND AIMS In children with chronic kidney disease (CKD), anaemia is defined as haemoglobin (Hb) <11–13.0 g/dL, depending on the patient's age and gender. Previous exploratory machine learning in a subpopulation of CKD-5 patients suggested an increased mortality risk with Hb < 10.5 g/dL and increased red blood cell distribution width (RDW) >15%. The objective was to evaluate such associations in a traditional time-to-event analysis in a larger population. METHOD Retrospective analysis of a cohort of patients < 30 years of age who started chronic haemodialysis (HD) in childhood (≤19 years) and received thrice-weekly HD (2004–2016) in outpatient DaVita centres. Survival at 5 years while remaining on HD was investigated by non-parametric analysis (Kaplan–Meier) stratified by terciles of mean individual Hb and RDW, respectively. A sensitivity analysis was carried out for different subpopulations (<6y/6y–12y/>12y at the initiation of HD). RESULTS A total of 493 patients were included with Hb and RDW terciles of < 10.7/10.7–11.5/>11.5 g/dL and < 14.6/14.6–15.7/>15.7%, respectively. Age at initiation of HD was < 6 years: n = 66, 6–12 years: n = 173, >12 years: n = 1254. Both Hb and RDW terciles showed strong associations with survival distributions (P < .001 for both, log-rank test). Estimated 5-year survival [95%confidence interval (95%CI)] by Hb terciles was 85.1% (81.1–89.3%) (Hb < 10.7 g/dL) versus 94.9% (92.5–97.4%) (>10.7–11.5 g/dL) and 93.8% (90.8–97.0%) (>11.5 g/dL) and for RDW 98.6% (97.1–100%) (<14.6%) versus 94.1% (91.3–96.9%) (14.6–15.7%) and 84.2% (80.1–88.6%) (>15.7%). Sensitivity analyses confirmed significant associations in patients > 12 years (P < .001 for both Hb/RDW) and for RDW in 6–12 years patients (P = .03 versus P = .14 for Hb). CONCLUSION This analysis confirmed strong associations between haematologic factors and survival in our population. Clinical utility of RDW in HD management and its physiological interpretation such as the importance of specific anaemia forms, or treatment-induced RDW increase in patients requiring more intense treatment remains to be investigated, with potential impacts on existing guidelines for prescribing iron and epoetin therapy. Further studies will also include the time variation trajectories of Hb and RDW.