Abstract
Long-term survival of children with end-stage renal disease (ESRD) has increased in the last 20 years, but the mortality rate remains high. Cardiovascular disease accounts for 40 to 50% of all deaths, infectious disease for about 20%. A prolonged period of dialysis versus having a renal graft and persistent hypertension are mortality risk factors. The prevalence of the various morbidities is high among those who have reached adulthood. Nearly 50% of all these patients suffer from left ventricular hypertrophy and life-threatening vascular changes; nearly one third has clinical signs of metabolic bone disease. This accounts for both dialysis and transplant recipients. The chance of getting cancer is increased ten times compared to the general population; skin cancer and non-Hodgkin lymphomas are most commonly reported. A long period of dialysis at childhood is associated with impairment of both cognitive and educational attainment. However, despite all these negative outcomes, the health perception of young adults with childhood onset ESRD is positive. Research and therapy in children with ESRD should focus not only on prevention of graft failure, but also on prevention of co-morbidity, especially cardiovascular disease, life-threatening infections and malignancies. Early transplantation, more extended forms of frequent hemodialysis in those who can not be transplanted, a more rigorous treatment of hypertension, avoidance or at least dosage reduction of calcium-containing phosphate binders, reduction of the chronic inflammatory state, and tailor made anti-rejection therapy after transplantation may all be targets to improve the outcome in future patients.
References
Kolff WJ (1946) De Kunstmatige nier, thesis. JH Kok, Kampen
Chantler C (1979) Renal failure in childhood. In: Black D, Jones NF (eds) Renal disease. Blackwell Scientific Publications, Oxford, pp 825–869
McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662
Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629
van der Heijden BJ, van Dijk PC, Verrier-Jones K, Jager KJ, Briggs JD (2004) Renal replacement therapy in children: data from 12 registries in Europe. Pediatr Nephrol 19:213–221
Offner G, Latta K, Hoyer PF, Baum HJ, Ehrich JH, Pichlmayr R, Brodehl J (1999) Kidney transplanted children come of age. Kidney Int 55:1509–1517
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2:100–105
Sorof JM, Turner J, Martin DS, Garcia K, Garami Z, Alexandrov AV, Wan F, Portman RJ (2004) Cardiovascular risk factors and sequelae in hypertensive children identified by referral versus school-based screening. Hypertension 43:214–218
Mitsnefes MM. (2004) Hypertension and end-organ damage in pediatric renal transplantation. Pediatr Transplant 8:394–399
Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2003) Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation 18:864–868
Mitsnefes M, Ho PL, McEnery PT (2003) Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol 14:2618–2622
Mitsnefes MM, Khoury PR, McEnery PT (2003) Early posttransplantation hypertension and poor long-term renal allograft survival in pediatric patients. J Pediatr 143:98–103
Vats AN, Donaldson L, Fine RN, Chavers BM (2000) Pretransplant dialysis status and outcome of renal transplantation in North American children: a NAPRTCS Study. North American Pediatric Renal Transplant Cooperative Study. Transplantation 69:1414–1419
Gruppen MP, Groothoff JW, Prins M, van der WP, Offringa M, Bos WJ, Davin JC, Heymans HS (2003) Cardiac disease in young adult patients with end-stage renal disease since childhood: a Dutch cohort study. Kidney Int 63:1058–1065
Groothoff JW, Gruppen MP, Offringa M, de GE, Stok W, Bos WJ, Davin JC, Lilien MR, vd Kar NC, Wolff ED, Heymans HS (2002) Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 13:2953–2961
Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC (1996) Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 27:394–401
Eifinger F, Wahn F, Querfeld U, Pollok M, Gevargez A, Kriener P, Gronemeyer D (2000) Coronary artery calcifications in children and young adults treated with renal replacement therapy. Nephrol Dial Transplant 15:1892–1894
Groothoff JW, Offringa M, Van Eck-Smit BL, Gruppen MP, Van De Kar NJ, Wolff ED, Lilien MR, Davin JC, Heymans HS (2003) Severe bone disease and low bone mineral density after juvenile renal failure. Kidney Int 63:266–275
Bartosh SM, Leverson G, Robillard D, Sollinger HW (2003)Long-term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation 76:1195–2000
el-Husseini AA, el-Agroudy AE, Wafa EW, Mohsen T, Sobh MA, Ghoneim MA (2004) Bone mineral density in live related kidney transplant children and adolescents. Int Urol Nephrol 36:95–100
Saland JM, Goode ML, Haas DL, Romano TA, Seikaly MG (2001) The prevalence of osteopenia in pediatric renal allograft recipients varies with the method of analysis. Am J Transplant 1:243–250
Coutinho HM, Groothoff JW, Offringa M, Gruppen MP, Heymans HS (2001) De novo malignancy after paediatric renal replacement therapy. Arch Dis Child 85:478–483
Groothoff JW, Grootenhuis M, Dommerholt A, Gruppen MP, Offringa M, Heymans HS (2002) Impaired cognition and schooling in adults with end stage renal disease since childhood. Arch Dis Child 87:380–385
Broyer M, Le BC, Charbit M, Guest G, Tete MJ, Gagnadoux MF, Niaudet P (2004) Long-term social outcome of children after kidney transplantation. Transplantation 77:1033–1037
Bawden HN, Acott P, Carter J, Lirenman D, MacDonald GW, McAllister M, McDonnell MC, Shea S, Crocker J (2004) Neuropsychological functioning in end-stage renal disease. Arch Dis Child 89:644–647
Groothoff JW, Grootenhuis M, Offringa M, Stronks K, Hutten J, Heymans HS (2005) Social consequences in adult life of end-stage renal disease of childhood. J Pediatrics (in press)
Ehrich JH, Rizzoni G, Broyer M, Brunner FP, Brynger H, Fassbinder W, Geerlings W, Selwood NH, Tuveson G, Wing AJ (1992) Rehabilitation of young adults during renal replacement therapy in Europe. 2. Schooling, employment, and social situation. Nephrol Dial Transplant 7:579–586
Rosenkranz J, Bonzel KE, Bulla M, Michalk D, Offner G, Reichwald-Klugger E, Scharer K (1992) Psychosocial adaptation of children and adolescents with chronic renal failure. Pediatr Nephrol 6:459–463
van Manen JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT (2001) Changes in employment status in end-stage renal disease patients during their first year of dialysis. Perit Dial Int 21:595–601
Groothoff JW, Grootenhuis MA, Offringa M, Gruppen MP, Korevaar JC, Heymans HS (2003) Quality of life in adults with end-stage renal disease since childhood is only partially impaired. Nephrol Dial Transplant 18:310–317
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Groothoff, J.W. Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 20, 849–853 (2005). https://doi.org/10.1007/s00467-005-1878-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-1878-9