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Long-Term Outcome of Kidney Failure in Children

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Pediatric Kidney Disease

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Abstract

Long-term prospects for children with kidney failure have improved dramatically over the past 40 years. Yet, the adjusted risk for premature death, especially at young adult age remains high. Historically, cardiovascular disease (CVD) has been by far the most important cause of death among patients with childhood-onset ESKD. Recent long-term outcome data show a shift towards infections as predominant threat, probably due to more effective prevention of cardiovascular disease and increasing ESKD time fractions spent with a functioning renal graft, as CVD is strongly related to time on dialysis. Comorbidities are highly prevalent in middle-aged patients with childhood-onset kidney failure ESKD, 20–30% of whom suffer from motor disabilities affecting routine activities. Furthermore, the patients are at increased risk of developing malignancies; squamous cell skin carcinoma is extremely prevalent among transplanted patients.

Childhood-onset ESKD also has an important impact on psychosocial life in early adulthood. Many patients show delay or underachievement on various key features of adult development. They tend to be relatively low educated, have difficulties in finding a partner, tend to stay living with their parents and have significant problems in obtaining paid work. However, patients older than 30 years appear to have a higher average educational level, are more frequently employed and have a significantly higher level of autonomy. Notably, adults with childhood-onset typically report a satisfactory quality of life, despite their frequently poor objective somatic condition.

Most adverse outcomes are associated with extended dialysis periods, emphasizing the need to aim for transplantation at the earliest possible time. Immunosuppressive regimes should be individualized to reduce toxicity. If long-term dialysis is inevitable, frequent home hemodialysis regiments should be considered to reduce toxicity and enhance autonomy. All pediatric ESKD treatment centers should foster active psychosocial programs promoting education and autonomy.

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  1. Emma Children’s Hospital, Amsterdam UMC/Location University of Amsterdam, Amsterdam, The Netherlands

    Jaap W. Groothoff

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  1. Division of Pediatric Nephrology, Heidelberg University, Heidelberg, Germany

    Franz Schaefer

  2. Emory School of Medicine, Emory University, Atlanta, GA, USA

    Larry A. Greenbaum

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Groothoff, J.W. (2023). Long-Term Outcome of Kidney Failure in Children. In: Schaefer, F., Greenbaum, L.A. (eds) Pediatric Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-11665-0_70

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