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Long-Term Outcome of Renal Insufficiency in Children

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Pediatric Kidney Disease

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Abstract

Long-term prospects for children with end-stage renal disease (ESRD) have improved tremendously 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 ESRD. Recent long-term outcome data show a shift towards infections as predominant threat, probably due to more effective prevention of cardiovascular disease and increasing ESRD 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 ESRD, 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 ESRD 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 in order to reduce toxicity. If long-term dialysis is inevitable, frequent home hemodialysis regiments should be considered in order to reduce toxicity and enhance autonomy. All pediatric ESRD treatment centers should foster active psychosocial programs promoting education and autonomy.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands

    Jaap W. Groothoff

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  1. Jaap W. Groothoff
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Correspondence to Jaap W. Groothoff .

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  1. Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Denis F. Geary

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

    Franz Schaefer

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Groothoff, J.W. (2016). Long-Term Outcome of Renal Insufficiency in Children. In: Geary, D., Schaefer, F. (eds) Pediatric Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52972-0_71

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  • DOI: https://doi.org/10.1007/978-3-662-52972-0_71

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