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A propensity-matched comparison of hard outcomes in children on chronic dialysis

  • Original Article
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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Data concerning outcomes of children on hemodialysis (HD) and peritoneal dialysis (PD) are scarce and frequently derived from single-center experiences. We sought to compare survival and transplantation rates in a large cohort of PD and HD patients. We extracted all patients initiating dialysis under 16 years of age between 2004 and 2013 from the Italian Registry of Pediatric Chronic Dialysis. Patients on PD were propensity-matched to those on HD based on gender, age, primary cause of ESRD, and the number of co-morbidities. Stratified Cox proportional hazard models were used to compare outcomes by dialysis modality. Three hundred ten patients were matched from 452 incident patients. In the unmatched cohort, PD patients were younger, more likely to be diagnosed with CAKUT, and had a higher urine output than HD patients. In the propensity-matched cohort, covariates were balanced between the two groups. At 2 years, the cumulative hazard ratio for death was similar (CHR 0.95, 95% CI 0.17–5.20) for HD relative to PD patients; and at 5 years, the CHR was lower for HD patients (0.22 95% CI 0.16–0.29). The cumulative incidence of transplantation at 3 years after dialysis initiation was 60.9% in HD patients and 59.7% in PD patients, with a CHR of 1.03 (95% CI 0.73–1.45).

Conclusions: Pediatric PD and HD patients have distinct characteristics. After controlling for treatment-selection biases, children selected to start on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk increases in PD children.

What is Known:

• Few studies have compared hard outcomes in children on maintenance dialysis.

• Children started on different dialysis modalities have distinct characteristics that impact on survival.

What is New:

• After controlling for treatment-selection biases, children selected to start dialysis on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk appears to be increased in PD children.

• An “integrative care” approach should be used in children on PD, switching them to HD when PD-related morbidity tends to increase.

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Abbreviations

CHR:

Cumulative hazard ratio

ESRD:

End-stage renal disease

HD:

Hemodialysis

PD:

Peritoneal dialysis

PSM:

Propensity score-matched

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Author information

Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman’s and Child’s Health, University-Hospital of Padova, Via Giustiniani 3, 35128, Padua, Italy

    Enrico Vidal & Luisa Murer

  2. ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, the Netherlands

    Nicholas C. Chesnaye

  3. Pediatric Nephrology and Dialysis Unit, Clinica Pediatrica De Marchi, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Fabio Paglialonga

  4. Nephrology and Dialysis Unit, Santobono Children’s Hospital, Naples, Italy

    Bruno Minale

  5. Nephrology and Urology Department, Bambino Gesù Children’s Hospital, Rome, Italy

    Giovanna Leozappa

  6. Nephrology Division, Giovanni XXIII Children’s Hospital, Bari, Italy

    Mario Giordano

  7. Nephrology, Dialysis and Transplantation Unit, Regina Margherita Children’s Hospital, Torino, Italy

    Bruno Gianoglio

  8. Pediatric Nephrology Unit, Children’s Hospital “G. Di Cristina”, A.R.N.A.S. “Civico”, Palermo, Italy

    Ciro Corrado

  9. Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy

    Rosa Maria Roperto

  10. Department of Pediatrics, Nephrology Unit, University School of Medicine, Messina, Italy

    Roberto Chimenz

  11. Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy

    Francesca Mencarelli

  12. Department of Pediatrics, University of Ancona, Ancona, Italy

    Ilse-Maria Ratsch

  13. Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy

    Enrico Verrina

Authors
  1. Enrico Vidal
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  2. Nicholas C. Chesnaye
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  3. Fabio Paglialonga
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  4. Bruno Minale
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  5. Giovanna Leozappa
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  6. Mario Giordano
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  7. Bruno Gianoglio
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  8. Ciro Corrado
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  9. Rosa Maria Roperto
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  10. Roberto Chimenz
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  11. Francesca Mencarelli
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  12. Ilse-Maria Ratsch
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  13. Luisa Murer
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  14. Enrico Verrina
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Consortia

on behalf of the Italian Registry for Paediatric Chronic Dialysis

Contributions

EVi and EVe conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. NC carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. FP, BM, GL, MG, BG, CC, RMR, RC, FM, IMR, and LM participated in data collection, critically revised the manuscript, and approved the final manuscript as submitted. All Authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Enrico Vidal.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Communicated by Mario Bianchetti

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Vidal, E., Chesnaye, N.C., Paglialonga, F. et al. A propensity-matched comparison of hard outcomes in children on chronic dialysis. Eur J Pediatr 177, 117–124 (2018). https://doi.org/10.1007/s00431-017-3040-7

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  • DOI: https://doi.org/10.1007/s00431-017-3040-7

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