European Journal of Pediatrics

, Volume 152, Issue 2, pp 166–171 | Cite as

Changning pattern of chronic renal failure and renal replacement therapy in children and adolescents: a 20-year single centre study

  • K. Schärer
  • U. Reiss
  • O. Mehls
  • N. Gretz
  • K. Möhring
  • D. E. Müller-Wiefel
  • A. Wingen
Nephrology/Urology

Abstract

We analysed the demographic data, clinical course and survival on different forms of renal replacement therapy (RRT) of 374 children and adolescents with chronic renal failure observed between 1969 and 1988 and compared the findings for the four subsequent 5-year periods. The proportion of children below 5 years of age rose from 21% to 47%. With time the incidence of glomerulonephritis increased and that of pyelonephritis decreased. As RRT became more common, more very young children and more adolescents were admitted to the study. In the last 5 years continuous ambulatory peritoncal dialysis (CAPD) and haemodialysis (HD) were performed to the same extent as the initial form of RRT. The time a subject had to wait for a first transplant decreased from 36 to 21 months. Between 1969 and 1988 overall survival on any form of RRT increased to 77% after 10 years of therapy. In the last observation period 2-year patient survival was 100% both on HD and CAPD. First cadaver graft survival after 4 years improved from 25% in 1969–1973 to 69% in 1984–1988.

Key words

Chronic renal failure Haemodialysis Continuous ambulatory peritoneal dialysis Renal transplantation Survival 

Abbreviations

CAPD

continuous ambulatory peritoneal dialysis

CRF

chronic renal failure

EDTA

European Dialysis and Transplant Association

ESRD

end-stage renal disease

HD

hacmodialysis

RRT

renal replacement therapy

SCr

serum creatinine concentration

TP

transplantation

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References

  1. 1.
    Alexander SR, Arbus GS, Butt KMH, Conley S, Fine RN, Greifer I, Gruskin AB, Harmon WE, McEnery PT, Nevins TF, Nogneira N, Salvatierra O, Tejani A (1990) The 1989 report of the North American pediatric renal transplant cooperative study, Pediatr Nephrol 4: 542–553PubMedGoogle Scholar
  2. 2.
    Appleton DR (1988) Analysis of data in nephrology. III. Survival analysis and analysis of variance. Nephrol Dial Transplant 3: 340–344PubMedGoogle Scholar
  3. 3.
    Australian Kidney Foundation Disney APS (ed) (1991) Fourteenth report of the Australia and New Zealand Dialysis and Transplant Registry. Australian Kidney Foundation, Woodwille, South AustraliaGoogle Scholar
  4. 4.
    Bonzel KE, Mehls O, Müller-Wiefel DE, Diekmann L, Wartha R, Ruder H, Rascher W, Schärer K (1986) Kontinuierliche ambulante Peritoncaldialyse (CAPD) bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 134: 197–204PubMedGoogle Scholar
  5. 5.
    Bonzel KE, Roth H, Schärer K (1989) Peritoneal access for dialysis in infants and children. In: Andreucci V (ed) Vascular peritoneal access for dialysis. Kluwer, Boston, pp 315–331Google Scholar
  6. 6.
    Brodehl J, Offner G, Hoyer F, Pichlmayr R (1990) Outcome in children with endstage renal disease. Acta Paediatr Jpn 32: 589–609Google Scholar
  7. 7.
    Broyer M, Brunner F, Brynger H, Fassbinder W, Guillou PJ, Oules R, Rizzoni G, Selwood NH, Wing AJ, Challah S, Dykes SR (1986) Demography of dialysis and transplantation in children in Europe, 1984. Nephrol Dial Transplant 1: 9–15PubMedGoogle Scholar
  8. 8.
    Broyer M, Gagnadoux MF, Guest G, Beurton D, Niaudet P, Habib R, Busson M (1987) Kidney transplantation in children: results of 383 grafts performed at Enfants Malades Hospital from 1973 to 1984. Adv Nephrol 16: 307–334Google Scholar
  9. 9.
    Broyer M, Chantler C, Donckerwolcke R, Rizzoni G (1990) Renal replacement therapy in children. In: Maher JF (ed) Replacement of renal function by dialysis, 3rd edn. M. Nijhoff, Boston, pp 720–749Google Scholar
  10. 10.
    Brunner FB, Broyer M, Brynger H, Dykes SR, Fassbinder W, Geerlings W, Rizzoni G, Selwood NH, Tufveson G, Wing AJ (1988) Demography of dialysis and transplantation in children in Europe. 1985. Nephrol Dial Transplant 3: 235–243PubMedGoogle Scholar
  11. 11.
    Canadian Renal Failure Register (1987) 1986 Report. Kidney Foundation of CanadaGoogle Scholar
  12. 12.
    Chantler C, Carter JR, Bewick M, Counahan R, Cameron J, Ogg CS, Williams DG, Winder E (1980) Ten year's experience with regular hemodialysis and renal transplantation in children. Arch Dis Child 55: 435–445PubMedGoogle Scholar
  13. 13.
    Ehrich J, Rizzoni G, Brunner FP, Brynger H, Geerlings W, Fassbinder W, Raine AEG, Selwood HN, Tufveson G (1991) Combined report on regular dialysis and transplantation of children in Europe, 1989. Nephrol Dial Transplant 6 [Suppl 1]: 37–47PubMedGoogle Scholar
  14. 14.
    Esbjörner F, Aronsson S, Berg U, Jodal U, Linne T (1990) Children with chronic renal failure in Sweden 1978–1985. Pediatr Nephrol 4: 249–252PubMedGoogle Scholar
  15. 15.
    Fine RN, Schärer K, Mehls O (eds) (1985) CAPD in children. Springer. Berlin Heidelberg New YorkGoogle Scholar
  16. 16.
    Gretz N, Meisinger E, Strauch M (1986) Survival analysis in the SAS system: a surevey. Proceedings of the SEUGI conference, Brighton, pp 3–10Google Scholar
  17. 17.
    Gretz N, Schärer K, Waldherr R, Strauch M (1989) Rate of deterioration of renal function in juvenile nephronophthisis. Pediatr Nephrol 3: 56–60PubMedGoogle Scholar
  18. 18.
    Koffmann CG, Rigden SPA, Bewick M, Chantler C, Haycock GB (1989) Renal transplantation in children less than five years of age. Transplant Proc 21: 2001–2002PubMedGoogle Scholar
  19. 19.
    Lee HM, Mendez-Picon G, Posner MP (1989) The status of rehabilitation, morbidity, and mortality of long-term survivors of pediatric kidney transplants. Transplant Proc 21: 1989–1991PubMedGoogle Scholar
  20. 20.
    Leumann EP, Egli F, Fanconi A, Guignard JP, Broyer M, Koegel R, Oetliker O, Paunir L (1984) Outcome of pediatric patients with end-stage renal disease in Switzerland 1973–1982. Int J Pediatr Nephrol 5: 155–159PubMedGoogle Scholar
  21. 21.
    Macker MA, Loirat C, Pillion G, Mathieu H (1986) Chronic renal insufficiency in the child. Etiology, development and prognosis. Arch Fr Pediatr 43: 401–406PubMedGoogle Scholar
  22. 22.
    Offner G, Aschendorff C, Hoyer PF, Krohn HP, Ehrich JHH, Pichlmayer R, Brodehl J (1988) Endstage renal failure: 14 years' experience of dialysis and renal transplantation. Arch Dis Child 63: 120–126PubMedGoogle Scholar
  23. 23.
    Ohmori Y, Aikawa I, Yashimura N, Oka T (1989) Long-term prognosis of kidney transplantation in children. Transplant Proc 21: 1992–1994PubMedGoogle Scholar
  24. 24.
    Oulès R, Fassbinder W, Broyer M, Brunner FP, Brynger H, Challah S, Guillou PJ, Rizzoni G, Selwood NH, Wing AJ (1986) Combined report on regular dialysis and transplantation in Europe, XVI, 1985. EDTA-EDA Registration Committee BaselGoogle Scholar
  25. 25.
    Picon G, Falque V, Cantot E, Dispa C, Bourlier-Najean B, Legre R, Viard L, Guys JM (1991) Place de la dialyse dans le traitement de l'insuffisance rénale terminale d l'enfant. Ann Pediatr (Paris) 38: 157–164Google Scholar
  26. 26.
    Pistor K, Olbing H, Schärer K, Arbeitsgemeinschaft für Pädiatrische Nephrologie (1985) Children with chronic renal failure in the Federal Republic of Germany. I. Epidemiology, modes of treatment, survival. Clin Nephrol 23: 272–277PubMedGoogle Scholar
  27. 27.
    Pistor K, Schärer K, Olbing H, Tamminen-Möbius T, Children with chronic renal failure in the Federal Republic of Germany. II. Primary renal diseases, age and intervals from early renal failure to renal death. Clin Nephrol 23: 278–284Google Scholar
  28. 28.
    Potter DE, Najarian J, Belzer F, Holliday MA, Horns G, Salvatierra O (1991) Long-term results of renal transplantation in children. Kidney Int 40: 752–756PubMedGoogle Scholar
  29. 29.
    Reiss U (1990) Nierenersatztherapie bei Kindern und Jugendlichen an der Universitäts-Kinderklinik Heidelberg 1969–1988. Thesis. University of HeidelbergGoogle Scholar
  30. 30.
    Rizzoni G, Ehrich JHH, Brunner H, Dykes SR, Geerlings W, Fassbinder W, Tufveson G, Selwood NH, Wing AJ (1989) Combined report on regular dialysis and transplantation of children in Europe, 1988. Nephrol Dial Transplant 4 [Suppl 4]: 31–40Google Scholar
  31. 31.
    Rizzoni G, Broyer M, Ehrich JHH, Selwood H, Brunner FB, Brynger H, Dykes SR, Fassbinder W, Geerlings W, Tufveson G, Wing A (1990) The use of continuous peritoneal dialysis in Europe for the treatment of children with end-stage renal failure. Data from the EDTA Registry. Nephrol Dial Transplant 5: 985–990PubMedGoogle Scholar
  32. 32.
    Roscoe JM, Smith LF, Williams EA, Stein M, Morton AR, Balfe JW, Arbus GS (1991) Medical and social outcome in adolescents with end-stage renal failure. Kidney Int 40: 948–953PubMedGoogle Scholar
  33. 33.
    Ruder H, Strehlau J, Schaefer F, Gretz N, Müller-Wiefel DE, Bonzel KE, Möhring K, Pomer S, Mehls O, Schärer K (1989) Low-dose cyclosporin — a therapy in cadaver ranal transplantation in children. Transplant Int 2: 203–208Google Scholar
  34. 34.
    SAS Institute Inc. (1989) SAS users' guide: Statistics version 5th edn. SAS Institute Inc., Cary, N. C.Google Scholar
  35. 35.
    Schärer K, Brunner FP, Gurland HJ, Härlen H, Parsons FM (1972) Combined report on regular dialysis and transplantation of children in Europe 1971. Proc Eur Dial Transplant Assoc 9: 191–200PubMedGoogle Scholar
  36. 36.
    Schärer K, Chantler C, Brunner FP, Gurland HJ, Jacobs C, Selwood NH, Spies G, Wing AJ (1976) Combined report on regular dialysis and transplantation on children in Europe, 1975. Proc Eur Dial Transplant Assoc 13: 59–103Google Scholar
  37. 37.
    Schärer K, Bonzel KE, Mehls O, Müller-Wiefel DE, Reichwald-Klugger E (1987) Home dialysis in children. In: Edifonti A, Bacchini M, Sereni F (eds) II congresso nazionale della societa italiana di nefrologia pediatrica. Abetre Edizione. Milan, pp 59–72Google Scholar
  38. 38.
    So SKS, Mauer SM, Nevins TE, Fryd DS, Sutherland DER, Ascher NL, Simmons RL, Najarian JS (1986) Current results in pediatric renal transplantation at the University of Minnesota. Kidney Int 30: 25–30Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • K. Schärer
    • 1
  • U. Reiss
    • 1
  • O. Mehls
    • 1
  • N. Gretz
    • 1
  • K. Möhring
    • 2
  • D. E. Müller-Wiefel
    • 1
  • A. Wingen
    • 1
  1. 1.Division of Paediatric Nephrology, Department of PaediatricsUniversity of HeidelbergHeidelbergGermany
  2. 2.Division of Urology, Department of SurgeryUniversity of HeidelbergHeidelbergGermany

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