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Survival analysis among pediatric patients receiving kidney replacement therapy: a Japanese nationwide cohort study

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Abstract

Background

Limited data are available on the survival and causes of death in pediatric patients with chronic kidney disease (CKD) stage 5 receiving kidney replacement therapy (KRT) in Asia.

Methods

Data were obtained from the Japanese nationwide cross-sectional CKD stage 5 survey on pediatric patients (<20 years of age) who started KRT from 2006 to 2013. The cohort was divided into three groups according to age at the start of KRT: <1, 1–5, and 6–19 years.

Results

Among the 701 children who were included, 59.3% were boys. Peritoneal dialysis was the most common initial modality of KRT (60.3%). Median age at KRT initiation was 10.2 years. Infants (<1 year old) accounted for 16.0% of the total cohort. Overall survival at 1 and 5 years was 97.2% and 92.5%, respectively. Infants had significantly lower survival rates than the other groups (hazard ratio, 5.35; 95% CI, 2.60–11.03; P < 0.001). In contrast, after the age of 1 year, the survival rate improved and did not differ from that of other age groups. The most common causes of death were infection (35.9%) and sudden death (15.4%).

Conclusions

The overall survival rate of pediatric patients with CKD stage 5 in Japan is like that in other high-income countries. Age at initiation of KRT is an important factor affecting survival since the poorest survival rate was observed in infants. Further improvement in infant dialysis therapy is still needed to improve survival of the youngest children.

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Acknowledgements

The authors thank all the patients, families, physicians, and institutes who contributed to the JSPN CKD Stage 5 Survey. The authors also thank doctors Akira Matsunaga, Toru Igarashi, Toshiyuki Ota, Takao Konomoto, Naoko Ito, Ryoko Harada, Takuya Fujimaru, and Kenichi Satomura; members of the JSPN CKD Stage 5 Survey Committee; doctors Yuko Akioka, Kenji Ishikura, Yuko Hamasaki, Yoshitomo Itami, Yoshimitsu Goto, Yoshihiko Ueda, Misako Hiramatsu, Shuich Ito, Osamu Uemura, Satoshi Sasaki, Ken Hatae, Hiroshi Hataya, Mikiya Fujieda, and Hiroshi Yoshimura; and members of the JSPN, the Japanese Society for Dialysis Therapy (JSDT), and the Japanese Society for Clinical Renal Transplantation (JSCRT) for their contributions to data collection.

Funding

This work was funded by the Japanese Society for Pediatric Nephrology (JSPN).

Author information

Authors and Affiliations

  1. Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan

    Daishi Hirano

  2. Showa University Research Administration Center, Showa University, Tokyo, Japan

    Eisuke Inoue

  3. Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan

    Mayumi Sako

  4. Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan

    Akira Ashida

  5. Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Masataka Honda

  6. Itabashi Chuo Medical Center, Tokyo, Japan

    Shori Takahashi

  7. Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan

    Kazumoto Iijima

  8. Department of Advanced Pediatric Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Kazumoto Iijima

  9. Department of Pediatric Nephrology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Motoshi Hattori

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  1. Daishi Hirano
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on behalf of the Japanese Society of Pediatric Nephrology

Contributions

D. H., A. A., and M. H. conceived and designed the study; D.H. and E.I. performed statistical analyses; D.H., E. I., and M.H. developed the figures; D.H. and M.H. drafted and revised the paper; all authors interpreted the data, provided intellectual content, and approved the final version of the manuscript.

Corresponding author

Correspondence to Daishi Hirano.

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Supplementary Fig. 1

The hazard ratio for a unit increase of age using spline function. To show the relationship more directly, we have plotted the hazard ratio for a unit increase of age using a spline function. (PNG 146 kb)

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Supplementary Table 1

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Hirano, D., Inoue, E., Sako, M. et al. Survival analysis among pediatric patients receiving kidney replacement therapy: a Japanese nationwide cohort study. Pediatr Nephrol 38, 1–7 (2023). https://doi.org/10.1007/s00467-022-05568-4

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