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



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.


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).


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.


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



United States Renal Data System


End-stage kidney disease


North American Pediatric Renal Trials and Collaborative Studies


Australia and New Zealand Dialysis and Transplant Registry


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


Kidney Disease Outcomes Quality Initiative


International Pediatric Peritoneal Dialysis Network


Chronic peritoneal dialysis


Renal replacement therapy


Interquartile range


Hazard ratio


  1. System USRD (2017) 2017 annual data report: atlas of pediatric end-stage renal disease in the United States. United States renal data system (USRDS). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

  2. Chavers BM, Molony JT, Solid CA, Rheault MN, Collins AJ (2015) One-year mortality rates in US children with end-stage renal disease. Am J Nephrol 41:121–128

    Article  Google Scholar 

  3. Coulthard MG, Crosier J (2002) Outcome of reaching end stage renal failure in children under 2 years of age. Arch Dis Child 87:511–517

    CAS  Article  Google Scholar 

  4. (2011) North American Pediatric Renal Trials and Collaborative Studies: NAPRTCS 2011 Annual Dialysis Report. The EMMES Corporation, Rockville, MD. [cited December 17, 2017]

  5. Carey WA, Talley LI, Sehring SA, Jaskula JM, Mathias RS (2007) Outcomes of dialysis initiated during the neonatal period for treatment of end-stage renal disease: a north American pediatric renal trials and collaborative studies special analysis. Pediatrics 119:e468–e473

    Article  Google Scholar 

  6. Rheault MN, Rajpal J, Chavers BM, Nevins TE (2009) Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease. Pediatr Nephrol 24:2035–2039

    Article  Google Scholar 

  7. Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease, 1990-2010. JAMA 309:1921–1929

    CAS  Article  Google Scholar 

  8. Verrina E, Zacchello G, Perfumo F, Edefonti A, Sorino P, Bassi S, Andreetta B, Cattarelli D, Capasso G, Consalvo G et al (1995) Clinical experience in the treatment of infants with chronic peritoneal dialysis. Adv Perit Dial 11:281–284

    CAS  PubMed  Google Scholar 

  9. Chesnaye NC, Bonthuis M, Schaefer F, Groothoff JW, Verrina E, Heaf JG, Jankauskiene A, Lukosiene V, Molchanova EA, Mota C, Peco-Antić A, Ratsch IM, Bjerre A, Roussinov DL, Sukalo A, Topaloglu R, Van Hoeck K, Zagozdzon I, Jager KJ, Van Stralen KJ, ESPN/ERA–EDTA registry (2014) Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry. Pediatr Nephrol 29:2403–2410

    Article  Google Scholar 

  10. van Stralen KJ, Borzych-Duzalka D, Hataya H, Kennedy SE, Jager KJ, Verrina E, Inward C, Ronnholm K, Vondrak K, Warady BA, Zurowska AM, Schaefer F, Cochat P (2014) Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period. Kidney Int 86:168–174

    Article  Google Scholar 

  11. Laakkonen H, Lonnqvist T, Valanne L, Karikoski J, Holmberg C, Ronnholm K (2011) Neurological development in 21 children on peritoneal dialysis in infancy. Pediatr Nephrol 26:1863–1871

    Article  Google Scholar 

  12. Vidal E, van Stralen KJ, Chesnaye NC, Bonthuis M, Holmberg C, Zurowska A, Trivelli A, Da Silva JEE, Herthelius M, Adams B, Bjerre A, Jankauskiene A, Miteva P, Emirova K, Bayazit AK, Mache CJ, Sanchez-Moreno A, Harambat J, Groothoff JW, Jager KJ, Schaefer F, Verrina E (2017) Infants requiring maintenance dialysis: outcomes of hemodialysis and peritoneal dialysis. Am J Kidney Dis 69:617–625

    Article  Google Scholar 

  13. Pollack S, Eisenstein I, Tarabeih M, Shasha-Lavski H, Magen D, Zelikovic I (2016) Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome. Pediatr Nephrol 31:305–313

    Article  Google Scholar 

  14. Carey WA, Martz KL, Warady BA (2015) Outcome of patients initiating chronic peritoneal dialysis during the first year of life. Pediatrics 136:e615–e622

    Article  Google Scholar 

  15. Feinstein S, Rinat C, Becker-Cohen R, Ben-Shalom E, Schwartz SB, Frishberg Y (2008) The outcome of chronic dialysis in infants and toddlers—advantages and drawbacks of haemodialysis. Nephrol Dial Transplant 23:1336–1345

    Article  Google Scholar 

  16. Kovalski Y, Cleper R, Krause I, Davidovits M (2007) Hemodialysis in children weighing less than 15 kg: a single-center experience. Pediatr Nephrol 22:2105–2110

    Article  Google Scholar 

  17. White CT, Gowrishankar M, Feber J, Yiu V (2006) Clinical practice guidelines for pediatric peritoneal dialysis. Pediatr Nephrol 21:1059–1066

    Article  Google Scholar 

  18. Foundation KDNK (2006) K/DOQI clinical practice recommendations for peritoneal dialysis adequacy. Am J Kidney Dis 48:S130–S158

    Article  Google Scholar 

  19. Fine J, Gray RJ (1999) A proportional hazards model for subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  20. Noordzij M, Leffondre K, van Stralen KJ, Zoccali C, Dekker FW, Jager KJ (2013) When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant 28:2670–2677

    Article  Google Scholar 

  21. Teh JC, Frieling ML, Sienna JL, Geary DF (2011) Attitudes of caregivers to management of end-stage renal disease in infants. Perit Dial Int 31:459–465

    Article  Google Scholar 

  22. Lantos JD, Warady BA (2013) The evolving ethics of infant dialysis. Pediatr Nephrol 28:1943–1947

    Article  Google Scholar 

  23. Verrina E, Edefonti A, Gianoglio B, Rinaldi S, Sorino P, Zacchello G, Lavoratti G, Maringhini S, Pecoraro C, Calevo MG, Turrini Dertenois L, Perfumo F (2004) A multicenter experience on patient and technique survival in children on chronic dialysis. Pediatr Nephrol 19:82–90

    Article  Google Scholar 

  24. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F (2012) Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 32(Suppl 2):S32–S86

    CAS  Article  Google Scholar 

  25. Warady BA, Neu AM, Schaefer F (2014) Optimal care of the infant, child, and adolescent on dialysis: 2014 update. Am J Kidney Dis 64:128–142

    Article  Google Scholar 

  26. Warady BA, Schaefer F, Alexander SR (2012) Pediatric Dialysis. Springer, New York

    Book  Google Scholar 

  27. Hogan J, Couchoud C, Bonthuis M, Groothoff JW, Jager KJ, Schaefer F, Van Stralen KJ (2016) Gender disparities in access to pediatric renal transplantation in Europe: data from the ESPN/ERA-EDTA registry. Am J Transplant 16:2097–2105

    CAS  Article  Google Scholar 

  28. Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 89:1346–1354

    Article  Google Scholar 

  29. Hijazi R, Abitbol CL, Chandar J, Seeherunvong W, Freundlich M, Zilleruelo G (2009) Twenty-five years of infant dialysis: a single center experience. J Pediatr 155:111–117

    Article  Google Scholar 

  30. Borzych-Duzalka D, Aki TF, Azocar M, White C, Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga A, Galanti M, Yavascan O, Leozappa G, Szczepanska M, Vondrak K, Tse KC, Schaefer F, Warady BA (2017) Peritoneal dialysis access revision in children: causes, interventions, and outcomes. Clin J Am Soc Nephrol 12:105–112

    Article  Google Scholar 

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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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Correspondence to Keia R. Sanderson.

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

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The authors declare that they have no conflicts of interest.

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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).

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