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Mortality outcomes and clinical background of children on maintenance dialysis without receiving kidney transplantation

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Abstract

Background

Some pediatric patients on maintenance dialysis may need end-of-life care in the future because of being excluded from the indication of kidney transplantation and experiencing difficulty in continuation of their dialysis. This study aimed to thoroughly elucidate mortality outcomes of children on maintenance dialysis including the cause of death and clinical background of exclusion from indication of transplantation.

Patients and methods

This single-center retrospective study enrolled 53 children who received kidney transplantation (5) or maintenance peritoneal dialysis (PD, 48) as initial renal replacement therapy (RRT). We examined the selected RRT modalities, mortality outcomes, clinical backgrounds of cause of death, and risk factors of excluding from future the indication of transplantation.

Results

Nine (17%) of all 53 patients, all receiving PD (9/48, 19%), were finally excluded from next RRT indication—7 were excluded due to severe extrarenal complications that indicated high risk for transplantation and 2 were excluded due to severe psychomotor retardation and at the guardians’ discretion. Patients who were excluded from the indication had a younger age at PD induction and higher proportion of cerebral and cardiac complications or psychomotor retardation than patients who were included in the indication. Of the nine patients, seven died; of which, one patient died due to fatal progression of extrarenal complications and six died due to infectious or noninfectious dialysis-related complications.

Conclusion

Patients with severe extrarenal complications or psychomotor retardation tend to be excluded from the indication of transplantation. Their condition becomes fatal because of the complications of long-term dialysis and progression in extrarenal complications.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Nephrology, Aichi Children’s Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan

    Satoshi Hibino, Ryoichi Kitagata, Tatsuya Nishimura, Keiro Kagata, Kazuki Tanaka & Naoya Fujita

Authors
  1. Satoshi Hibino
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  2. Ryoichi Kitagata
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  3. Tatsuya Nishimura
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  4. Keiro Kagata
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  5. Kazuki Tanaka
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  6. Naoya Fujita
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by SH, KT, and NF. The first draft of the manuscript was written by SH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Satoshi Hibino.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the study was conducted (IRB approval number 2020023) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hibino, S., Kitagata, R., Nishimura, T. et al. Mortality outcomes and clinical background of children on maintenance dialysis without receiving kidney transplantation. Clin Exp Nephrol 26, 198–204 (2022). https://doi.org/10.1007/s10157-021-02132-6

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  • DOI: https://doi.org/10.1007/s10157-021-02132-6

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