Skip to main content

Advertisement

SpringerLink
Log in

Practice patterns and outcomes of maintenance dialysis in children < 2 years of age: a report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Peritoneal dialysis (PD) is the preferred mode of kidney replacement therapy (KRT) in infants and young children with kidney failure. Hemodialysis (HD) is used less often due to the technical challenges and risk of complications in smaller patients. There are limited data on chronic HD in this patient population.

Methods

This was a retrospective study of children younger than 24 months on HD and PD in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry between January 1992 and December 2018. We compared demographic, clinical, and laboratory data and outcomes, including patient survival and kidney transplantation.

Results

We identified 1125 infants and toddlers younger than 2 years of age who initiated KRT from January 1992 to December 2018. Of those, 1011 (89.8%) initiated peritoneal dialysis and 114 (10.2%) initiated hemodialysis. Median (IQR) age at HD onset was 12 (5.6–18.7) months compared to 4.6 (0.8–11.7) months at PD onset (p < 0.001). The primary cause of kidney failure with replacement therapy was congenital anomalies of the kidney and urinary tract (56.2% of PD versus 39.5% of HD group). Patients on HD had superior growth and nutrition markers than those on PD. Patient survival was similar between the two groups.

Conclusions

While HD may not be the modality of choice for chronic KRT in younger children, 10% of children younger than 24 months of age receive maintenance HD and the numbers have increased over time. Patient survival on dialysis is similar irrespective of dialysis modality.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analyzed during the current study are not publicly available but may be available from NAPRTCS with IRB approval.

Code availability

Not applicable.

References

  1. Chua AN, Warady BA (2017) Care of the pediatric patient on chronic dialysis. Adv Chronic Kidney Dis 24:388–397

    Article  Google Scholar 

  2. Vidal E, van Stralen KJ, Chesnaye NC, Bonthuis M, Holmberg C, Zurowska A, Trivelli A, Da Silva JEE, Herthelius M, Adams B, Bjerre A, Jankauskiene A, Miteva P, Emirova K, Bayazit AK, Mache CJ, Sanchez-Moreno A, Harambat J, Groothoff JW, Jager KJ, Schaefer F, Verrina E, European Society for Pediatric Nephrology (ESPN)/European Renal Association-European Dialysis and Transplant Association Registry (ERA-EDTA) (2017) Infants requiring maintenance dialysis: outcomes of hemodialysis and peritoneal dialysis. Am J Kidney Dis 69(617):625

    Google Scholar 

  3. Feinstein S, Rinat C, Becker-Cohen R, Ben-Shalom E, Schwartz SB, Frishberg Y (2008) The outcome of chronic dialysis in infants and toddlers–advantages and drawbacks of haemodialysis. Nephrol Dial Transplant 23:1336–1345

    Article  Google Scholar 

  4. Pollack S, Eisenstein I, Tarabeih M, Shasha-Lavski H, Magen D, Zelikovic I (2016) Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome. Pediatr Nephrol 31:305–313

    Article  Google Scholar 

  5. Shroff R, Wright E, Ledermann S, Hutchinson C, Rees L (2003) Chronic hemodialysis in infants and children under 2 years of age. Pediatr Nephrol 18:378–383

    Article  Google Scholar 

  6. Raina R, Vijayaraghavan P, Kapur G, Sethi SK, Krishnappa V, Kumar D, Bunchman TE, Bolen SD, Chand D (2018) Hemodialysis in neonates and infants: a systematic review. Semin Dial 31:289–299

    Article  Google Scholar 

  7. Kaur A, Davenport A (2014) Hemodialysis for infants, children, and adolescents. Hemodial Int 18:573–582

    Article  Google Scholar 

  8. Haffner D (2020) Strategies for optimizing growth in children with chronic kidney disease. Front Pediatr 8:399

    Article  Google Scholar 

  9. Gotta V, Marsenic O, Pfister M (2018) Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults. Nephrol Dial Transplant 33:1649–1660

    CAS  PubMed  Google Scholar 

  10. Müller D, Goldstein SL (2011) Hemodialysis in children with end-stage renal disease. Nat Rev Nephrol 7:650–658

    Article  Google Scholar 

  11. Weaver DJ Jr, Somers MJG, Martz K, Mitsnefes MM (2017) Clinical outcomes and survival in pediatric patients initiating chronic dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study registry. Pediatr Nephrol 32:2319–2330

    Article  Google Scholar 

  12. Quinlan C, Bates M, Sheils A, Dolan N, Riordan M, Awan A (2012) Chronic hemodialysis in children weighing less than 10 kg. Pediatr Nephrol 28:803–809

    Article  Google Scholar 

  13. Warady BA, Hebert D, Sullivan EK, Alexander SR, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:49–64

    Article  CAS  Google Scholar 

  14. Fischbach M, Edefonti A, Schroder C, Watson A, European Pediatric Dialysis Working Group (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066

    Article  Google Scholar 

  15. Minnick ML, Boynton S, Ndirangu J, Furth S (2010) Sex, race, and socioeconomic disparities in kidney disease in children. Semin Nephrol 30:26–32

    Article  Google Scholar 

  16. Furth SL, Powe NR, Hwang W, Neu AM, Fivush BA (1997) Racial differences in choice of dialysis modality for children with end-stage renal disease. Pediatrics 99:E6

    Article  CAS  Google Scholar 

  17. Leonard MB, Donaldson LA, Ho M, Geary DF (2003) A prospective cohort study of incident maintenance dialysis in children: an North American Pediatric Renal Transplant Cooperative Study. Kidney Int 63:744–755

    Article  Google Scholar 

  18. Paglialonga F, Consolo S, Pecoraro C, Vidal E, Gianoglio B, Puteo F, Picca S, Saravo MT, Edefonti A, Verrina E (2016) Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry. Pediatr Nephrol 31:833–841

    Article  Google Scholar 

  19. Wightman A, Zimmerman C, Neul S, Lepere K, Cedars K, Opel D (2019) Caregiver experience in pediatric dialysis. Pediatrics 143:e20182102

    Article  Google Scholar 

  20. Kaiser BA, Polinsky MS, Stover J, Morgenstern BZ, Baluarte HJ (1994) Growth of children following the initiation of dialysis: a comparison of three dialysis modalities. Pediatr Nephrol 8:733–738

    Article  Google Scholar 

  21. Turenne MN, Port FK, Strawderman RL, Ettenger RB, Alexander SR, Lewy JE, Jones CA, Agodoa LY, Held PJ (1997) Growth rates in pediatric dialysis patients and renal transplant recipients. Am J Kidney Dis 30:193–203

    Article  CAS  Google Scholar 

  22. Achinger SG, Ayus JC (2019) When the source of inflammation is hiding in plain sight: failed kidney transplants, clotted arteriovenous grafts, and central venous catheters. Semin Dial 32:15–21

    Article  Google Scholar 

  23. Ağbaş A, Canpolat N, Çalışkan S, Yılmaz A, Ekmekçi H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R (2018) Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children. PLoS One 13:e0198320

    Article  Google Scholar 

  24. Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease, 1990–2010. JAMA 309:1921–1929

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Elizabeth D. Yu, Raj Munshi, Jodi M. Smith & Shina Menon

  2. The Emmes Company, LLC, Rockville, MD, USA

    Shirley Galbiati

Authors
  1. Elizabeth D. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shirley Galbiati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raj Munshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jodi M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shina Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the NAPRTCS Investigators

Corresponding author

Correspondence to Elizabeth D. Yu.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 97 KB)

Supplementary file2 (DOCX 70 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, E.D., Galbiati, S., Munshi, R. et al. Practice patterns and outcomes of maintenance dialysis in children < 2 years of age: a report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Pediatr Nephrol 37, 1117–1124 (2022). https://doi.org/10.1007/s00467-021-05287-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-021-05287-2

Keywords

Search

Navigation