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Glomerular disease patients have higher odds not to reach quality targets in chronic dialysis compared with CAKUT patients: analyses from a nationwide German paediatric dialysis registry

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Abstract

Background

Paediatric dialysis patients still suffer from high morbidity rates. To improve this, quality assurance programs like the German QiNKid (Quality in Nephrology for Children)-Registry have been developed. In our study, the significance of underlying renal disease on a range of clinical and laboratory parameters impacting morbidity and mortality was analysed. Our aim was to evaluate whether or not disease-specific dialysis strategies should be considered in planning dialysis for a patient.

Methods

Inclusion criteria were defined as follows: (1) CAKUT (congenital anomalies of the kidney and urinary tract) or glomerular disease patient, (2) < 18 years of age, (3) haemodialysis or peritoneal dialysis patient. Only measurements obtained from day 90 to 365 after the date of the first dialysis in the registry were analysed. Laboratory (serum albumin, haemoglobin, ferritin, calcium, phosphate, parathyroid hormone) and clinical parameters (height, blood pressure) were analysed using mixed effects models accounting for the correlation of repeated measures in individual patients.

Results

The study cohort comprised n = 167 CAKUT and n = 55 glomerular disease patients. Glomerular disease patients had significantly higher odds of hypoalbuminemia (OR 13.90, 95% CI 1.35–159.99; p = 0.0274), anaemia (OR 3.31, 95% CI 1.22–9.13; p = 0.0197), hyperphosphatemia (OR 9.69, 95% CI 2.65–37.26; p = 0.0006) and diastolic hypertension (OR 3.38, 95% CI 1.20–9.79; p = 0.0212).

Conclusions

Glomerular disease patients might require more intensive dialysis regimens. The evaluation of hydration status should be given more attention, since conditions differing between the cohorts can be linked to overhydration. The QiNKid-Registry allows monitoring of the quality of paediatric dialysis in a nationwide cohort.

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Acknowledgements

We would like to thank the patients and staff of all German paediatric KfH centres for their support and data contribution. Our thanks go to Dominik Mueller (Berlin), Wolfgang Rascher (Erlangen), Rainer Buescher and Peter Hoyer (Essen), Matthias Hansen (Frankfurt), Martin Pohl (Freiburg), Jun Oh (Hamburg), Dieter Haffner and Lars Pape (Hannover), Franz Schaefer (Heidelberg), Ulrike John (Jena), Lutz Weber (Köln), Simone Wygoda (Leipzig), Guenter Klaus and Stefanie Weber (Marburg), Henry Fehrenbach (Memmingen), Carmen Montoya (München), Martin Konrad (Münster), and Hagen Staude (Rostock) representing the respective centres. We sincerely appreciate the constant commitment to this registry. In addition, we would like to thank Roswitha Breuer from the QiN-Registry for her ongoing efforts to ensure data entry in the QiNKid-Registry.

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Author notes

  1. Katrin Lübbe and Eva Nüsken contributed equally to this work.

Authors and Affiliations

  1. Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Katrin Lübbe, Eva Nüsken, Lutz T. Weber & Jörg Dötsch

  2. QiN-Group, Department of Medicine II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Katherine Rascher, Gero von Gersdorff & Heyke Cramer

  3. Institute of Medical Statistics, Informatics and Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Christina Samel

  4. KfH-Curatorium for Dialysis and Kidney Transplantation e.V., Neu-Isenburg, Germany

    Claudia Barth & Dieter Bach

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  1. Katrin Lübbe
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Correspondence to Eva Nüsken.

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Patient data in the QiNKid-Registry are collected automatically in an anonymous form after a declaration of consent has been signed by the legal guardian.

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Lübbe, K., Nüsken, E., Rascher, K. et al. Glomerular disease patients have higher odds not to reach quality targets in chronic dialysis compared with CAKUT patients: analyses from a nationwide German paediatric dialysis registry. Pediatr Nephrol 34, 1229–1236 (2019). https://doi.org/10.1007/s00467-019-04218-6

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