Pediatric Nephrology

, Volume 21, Issue 2, pp 257–264

Long-term outcome of chronic dialysis in children

  • Rukshana Shroff
  • Lesley Rees
  • Richard Trompeter
  • Carol Hutchinson
  • Sarah Ledermann
Original Article

Abstract

We describe the outcome since 1984 of all children receiving chronic dialysis in our centre for >3 months with a minimum follow-up of 5 (median 7.2) years. There were 98 children (61 boys), with a median age at the start of dialysis of 4.2 (range: birth to 16.2) years. Twenty-one children started dialysis at <1 year of age and 54 under <5 years. Thirty children had significant comorbidity. The median time on dialysis was 1.4 (0.3 to 14.4) years, giving a total dialysis experience of 296 patient-years. Fifty-three children received a renal transplant as their first change of treatment modality, but 31 switched between PD and HD, with a total of 54 changes of dialysis modality pre-transplantation. Twenty-one of the transplanted patients (39%) returned to dialysis. There were a total of 115 transplants in 88 patients. There was a positive increase for both the weight and height SDS for all the age groups while on dialysis, but this did not reach statistical significance. There were 17 deaths over the 20-year study period; of these, 10 died on dialysis. The overall patient survival was 83%. The mortality rate was 2.7 times greater in children who required renal replacement therapy under the age of 5 years. Of the deaths, 76% were in association with comorbid conditions. In conclusion, both a younger age at the start of renal replacement therapy and comorbidity are significant risk factors for death. The number of returnees to dialysis highlights the importance of conserving dialysis access.

Keywords

End-stage renal disease (ESRD) Renal replacement therapy (RRT) Peritoneal dialysis (PD) Haemodialysis (HD) Comorbidity Long-term outcome 

References

  1. 1.
    U.S. Renal Data System (2003) Annual data report: atlas of end stage renal disease in the United States. (http://www.usrds.org/2003/pdf/08_pediatrics_03.pdf, accessed 31 August 2004)Google Scholar
  2. 2.
    UK Renal Registry (2003) Report of the Paediatric Renal Registry in the UK Renal Registry, Sixth Annual Report. Ed Ansell, Feest, pp 205–230Google Scholar
  3. 3.
    McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662CrossRefPubMedGoogle Scholar
  4. 4.
    Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, van de Kar NJ, Wolff ED, Davin JC, Heymans HAS (2002) Mortality and causes of death of end-stage renal disease in children: A Dutch cohort study. Kidney Int 61:621–629CrossRefPubMedGoogle Scholar
  5. 5.
    North American Pediatric Renal Transplant Cooperative Study (2003) Annual report. (http://spitfire.emmes.com/study/ped/resources/annlrept.pdf, accessed 31 August 2004)Google Scholar
  6. 6.
    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 19:213–221CrossRefPubMedGoogle Scholar
  7. 7.
    Geary DF (1998) Attitudes of pediatric nephrologists to management of end-stage renal disease in infants. J Pediatr 133:154–156PubMedGoogle Scholar
  8. 8.
    Bunchman TE (1996) The ethics of infant dialysis. Perit Dial Inter 16:S3–S6Google Scholar
  9. 9.
    Rees L (2002) Management of the infant with end-stage renal failure. Nephrol Dialysis Transplant 17:1564–1567CrossRefGoogle Scholar
  10. 10.
    Neu AM, Ho PL, McDonald RA, Warady BA (2002) Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol 17:656–663CrossRefPubMedGoogle Scholar
  11. 11.
    National Kidney Foundation (1997) K/DOQI clinical practice guidelines for vascular access, guidelines 5–7. National Kidney Foundation, New York, pp 26–30Google Scholar
  12. 12.
    Renal Association (1997) Recommended standards for dialysis. In: Treatment of adult patients with renal failure: recommended standards and audit measures, 2nd edn. The Renal Association, pp 17–29Google Scholar
  13. 13.
    Coulthard MG, Crosier J (2002) Outcome of reaching end stage renal failure in children under 2 years of age. Arch Dis Child 87:511–517CrossRefPubMedGoogle Scholar
  14. 14.
    Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L (2000) Outcome and growth of infants with severe chronic renal failure. Kidney Int 57:1681–1687CrossRefPubMedGoogle Scholar
  15. 15.
    Shroff R, Wright E, Ledermann S, Hutchinson C, Rees L (2003) Chronic hemodialysis in infants and children under 2 years of age. Pediatr Nephrol 18:378–383PubMedGoogle Scholar
  16. 16.
    Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS (2000) Long-term outcome of peritoneal dialysis in infants. J Pediatr 136:24–29CrossRefPubMedGoogle Scholar
  17. 17.
    Ledermann SE, Spitz L, Moloney J, Rees L, Trompeter RS (2002) Gastrostomy feeding in infants and children on peritoneal dialysis. Pediatr Nephrol 17:246–250CrossRefPubMedGoogle Scholar
  18. 18.
    Ledermann SE, Shaw V, Trompeter RS (1999) Long-term enteral nutrition in infants and young children with chronic renal failure. Pediatr Nephrol 13:870–875CrossRefPubMedGoogle Scholar
  19. 19.
    Neu AM, Bedinger M, Fivush BA, Warady BA, Watkins SL, Friedman AL, Brem AS, Goldstein SL, Frankenfield DL (2005) Growth in adolescent hemodialysis patients: Data from the Centers for Medicare and Medicaid Services ESRD clinical performance measures project. Pediatr Nephrol 20:1156–1160CrossRefPubMedGoogle Scholar
  20. 20.
    Crompton CH, Australian and New Zealand Paediatric Nephrology Association (2004) Long-term recombinant human growth hormone use in Australian children with renal disease. Nephrology (Carlton) 9:325–330Google Scholar
  21. 21.
    Kari JA, Rees L (2004) Growth hormone for children with chronic renal failure and on dialysis. Pediatr Nephrol DOI: 10.1007/s00467-004-1801-9Google Scholar
  22. 22.
    Kari JA, Romagnoli J, Fernando ON, Rees L, Trompeter RS (1999) Renal transplantation in children under 5 years of age. Pediatr Nephrol 13:730–736CrossRefPubMedGoogle Scholar
  23. 23.
    Groothoff JW, Lilien MR, van de Kar NC, Wolff ED, Davin JC (2005) Cardiovascular disease as a late complication of end-stage renal disease in children. Pediatr Nephrol 20:374–379CrossRefPubMedGoogle Scholar
  24. 24.
    Groothoff JW (2005) Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 20:849–853CrossRefPubMedGoogle Scholar
  25. 25.
    Wood EG, Hand M, Briscoe DM, Donaldson LA, Yiu V, Harley FL, Warady BA, Ellis EN (2001) Risk factors for mortality in infants and young children on dialysis. The North American Pediatric Renal Transplant Cooperative Study. Am J Kidney Dis 37:573–579PubMedGoogle Scholar
  26. 26.
    Verrina E, Edifonti A, Gianoglio B, Rinaldi S, Sorino P, Zachello G, Lavoratti G, Maringhini S, Pecoraro C, Calevo MG, Turrini DL, Perfumo F (2004) A multicenter experience on patient and technique survival in children on chronic dialysis. Pediatr Nephrol 19:82–90CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2005

Authors and Affiliations

  • Rukshana Shroff
    • 1
  • Lesley Rees
    • 1
  • Richard Trompeter
    • 1
  • Carol Hutchinson
    • 1
  • Sarah Ledermann
    • 1
  1. 1.Department of NephrourologyGreat Ormond Street Hospital for Children NHS Trust LondonLondonUK

Personalised recommendations