Pediatric Nephrology

, Volume 27, Issue 10, pp 1975–1983

Survival and transplantation outcomes of children less than 2 years of age with end-stage renal disease

  • R. Todd Alexander
  • Bethany J. Foster
  • Marcello A. Tonelli
  • Andrea Soo
  • Alberto Nettel-Aguirre
  • Brenda R. Hemmelgarn
  • Susan M. Samuel
  • of the Pediatric Renal Outcomes Group Canada
Original Article

DOI: 10.1007/s00467-012-2195-8

Cite this article as:
Alexander, R.T., Foster, B.J., Tonelli, M.A. et al. Pediatr Nephrol (2012) 27: 1975. doi:10.1007/s00467-012-2195-8

Abstract

Background

Young children with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) have traditionally experienced high rates of morbidity and mortality; however, detailed long-term follow-up data is limited.

Methods

Using a population-based retrospective cohort with data from a national organ failure registry and administrative data from Canada’s universal health care system, we analysed the outcomes of 87 children starting RRT (before age 2 years) and followed them until death or date of last contact [median follow-up 4.7 years, interquartile range (IQR) 1.4–9.8). We assessed secular trends in survival and the influence of: (1) age at start of RRT and (2) etiology of ESRD with survival and time to transplantation.

Results

Patients were mostly male (69.0 %) with ESRD predominantly due to renal malformations (54.0 %). Peritoneal dialysis was the most common initial RRT (83.9 %). Fifty-seven (65.5 %) children received a renal transplant (median age at first transplant: 2.7 years, IQR 2.0–3.3). During 490 patient-years of follow-up, there were 23 (26.4 %) deaths, of which 22 occurred in patients who had not received a transplant. Mortality was greater for patients commencing dialysis between 1992 and 1999 and among the youngest children starting RRT (0–3 months). Children with ESRD secondary to renal malformations had better survival than those with ESRD due to other causes. Among the transplanted patients, all but one survived to the end of the observation period.

Conclusion

Children who start RRT before 3 months of age have a high risk of mortality. Among our paediatric patient cohort, mortality rates were much lower among children who had received a renal transplant.

Keywords

Infants Children ESRD Dialysis and transplantation 

Supplementary material

467_2012_2195_MOESM1_ESM.doc (31 kb)
ESM 1(DOC 31 kb)

Copyright information

© IPNA 2012

Authors and Affiliations

  • R. Todd Alexander
    • 1
    • 2
    • 10
  • Bethany J. Foster
    • 3
    • 4
  • Marcello A. Tonelli
    • 5
  • Andrea Soo
    • 6
  • Alberto Nettel-Aguirre
    • 7
    • 8
  • Brenda R. Hemmelgarn
    • 9
  • Susan M. Samuel
    • 7
    • 8
  • of the Pediatric Renal Outcomes Group Canada
  1. 1.Department of PediatricsUniversity of AlbertaEdmontonCanada
  2. 2.Stollery Children’s HospitalEdmontonCanada
  3. 3.Department of PediatricsMcGill UniversityMontrealCanada
  4. 4.Montreal Children’s HospitalMontrealCanada
  5. 5.Department of MedicineUniversity of AlbertaEdmontonCanada
  6. 6.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  7. 7.Department of PediatricsUniversity of CalgaryCalgaryCanada
  8. 8.Alberta Children’s HospitalCalgaryCanada
  9. 9.Faculty of MedicineUniversity of CalgaryCalgaryCanada
  10. 10.Division of Nephrology, Department of Pediatrics, Edmonton Clinic Health Academy University of AlbertaEdmontonCanada