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Outcomes of infants receiving chronic peritoneal dialysis: an analysis of the USRDS registry

Abstract

Background

Outcome data for infants on chronic peritoneal dialysis (CPD) is limited and has been based primarily on the analyses of voluntary entry registry data. In contrast, the United States Renal Data Systems (USRDS) collects data on all infants with end-stage kidney disease (ESKD) on chronic dialysis in the USA. We aimed to describe the clinical characteristics of this population and to determine the associated patient mortality.

Methods

The USRDS database was reviewed retrospectively for data on infants who initiated CPD at ≤ 12 months of age from 1990 to 2014. Infants were categorized into four groups, CPD initiation age (≤ 1 month of age or neonates and > 1–12 months of age or older infants) and initiation era (1990–1999 and 2000–2014).

Results

A total of 1723 infants (574 neonates and 1149 older infants) were identified. Overall, 20.9% of infants (147 neonates and 213 older infants) died on dialysis during the follow-up. The most commonly identified causes of death on dialysis were cardiorespiratory disease (25.8%) and infection (22.8%). There was an increased risk for mortality in all infants who initiated CPD in the earlier initiation era (1990–1999) vs the later era (2000–2014) (aHR of 1.95), for females vs males (aHR 1.43), and for those with a primary diagnosis of cystic kidney diseases vs congenital anomalies of the kidney and urinary tract (CAKUT) (aHR 1.84). In 2000–2014, patient survival at 1 and 5 years was 86.8% and 74.6% for those who initiated CPD as neonates and 89.6% and 79.3% for those who did so as older infants.

Conclusions

In this large cohort of infants who received chronic peritoneal dialysis over more than two decades, the probability of survival after initiating CPD in the first year of life has significantly improved. There is no difference in the probability of death for neonates compared to older infants. However, the mortality rate remains substantial in association with multiple risk factors.

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Fig. 1

Abbreviations

USRDS:

United States Renal Data System

ESKD:

End-stage kidney disease

NAPRTCS:

North American Pediatric Renal Trials and Collaborative Studies

ANZDATA:

Australia and New Zealand Dialysis and Transplant Registry

ESPN/ERA-EDTA:

European Society for Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association

KDOQI:

Kidney Disease Outcomes Quality Initiative

IPPN:

International Pediatric Peritoneal Dialysis Network

CPD:

Chronic peritoneal dialysis

RRT:

Renal replacement therapy

IQR:

Interquartile range

HR:

Hazard ratio

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Funding

The primary author is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR001109. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Corresponding author

Correspondence to Keia R. Sanderson.

Ethics declarations

The study was approved by the Institutional Review Boards of Children’s Mercy Kansas City and the University of North Carolina.

Conflict of interest

The authors declare that they have no conflicts of interest.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

“The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author (s) and in no way should be seen as an official policy or interpretation of the US government.”

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Sanderson, K.R., Yu, Y., Dai, H. et al. Outcomes of infants receiving chronic peritoneal dialysis: an analysis of the USRDS registry. Pediatr Nephrol 34, 155–162 (2019). https://doi.org/10.1007/s00467-018-4056-6

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  • DOI: https://doi.org/10.1007/s00467-018-4056-6

Keywords

  • Peritoneal dialysis
  • Chronic peritoneal dialysis
  • Pediatric ESKD
  • Infants
  • Neonates