Original Article

Pediatric Nephrology

, Volume 27, Issue 10, pp 1975-1983

First online:

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

  • R. Todd AlexanderAffiliated withDepartment of Pediatrics, University of AlbertaStollery Children’s HospitalDivision of Nephrology, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta Email author 
  • , Bethany J. FosterAffiliated withDepartment of Pediatrics, McGill UniversityMontreal Children’s Hospital
  • , Marcello A. TonelliAffiliated withDepartment of Medicine, University of Alberta
  • , Andrea SooAffiliated withDepartment of Community Health Sciences, University of Calgary
  • , Alberto Nettel-AguirreAffiliated withDepartment of Pediatrics, University of CalgaryAlberta Children’s Hospital
  • , Brenda R. HemmelgarnAffiliated withFaculty of Medicine, University of Calgary
  • , Susan M. SamuelAffiliated withDepartment of Pediatrics, University of CalgaryAlberta Children’s Hospital
  • , of the Pediatric Renal Outcomes Group Canada

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access



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.


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.


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.


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.


Infants Children ESRD Dialysis and transplantation