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Variation in estimated glomerular filtration rate at dialysis initiation in children

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Abstract

Background

Data guiding the timing of dialysis initiation in children are limited. We sought to determine current practice and secular trends in Canada with respect to the timing of dialysis initiation in children based on estimated glomerular filtration rate (eGFR).

Methods

This observational study included incident chronic dialysis patients aged ≤21 years identified from the Canadian Organ Replacement Register who started dialysis in Canada between January 2001 and December 2010 at any of the nine participating Canadian centers (n = 583). Youth were categorized utilizing CKiD Schwartz eGFR into ≥10.5 (higher) or <10.5 ml/min/1.73 m2 (lower) eGFR groups. Differences at dialysis initiation by facility and region were examined, and secular trends were determined.

Results

Median eGFR at dialysis initiation was 8.1 (interquartile range 5.4–11.0) ml/min/1.73 m2. Overall, 29 % of the patients started dialysis with an eGFR of ≥10.5 ml/min/1.73 m2. The proportion of children starting with higher eGFR increased from 27.3 % in 2001 to 35.4 % in 2010 (p = 0.04) and differed by treatment facility (12–70 %; p = 0.0001). Factors associated with higher eGFR at dialysis initiation in the adjusted regression model were female sex [odds ratio (OR) 1.48; 95 % confidence interval (CI) 1.02–2.14], genetic cause of end-stage kidney disease (OR 2.77; 95 % CI 1.37–5.58) and living ≥50 km from treatment facility (OR 1.47; 95 % CI 1.01–2.14).

Conclusions

One-third of the children were found to have initiated dialysis with an eGFR ≥10.5 ml/min/1.73 m2, however significant practice variation exists with respect to timing of dialysis initiation by treatment facility. More data is required to evaluate the clinical implications of this practice variation.

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References

  1. Canadian Institute for Health Information (2013) Canadian organ replacement register annual report: Treatment of end-stage organ failure in Canada, 2002-11. Available at: https://secure.cihi.ca/free_products/2013_CORR_Annua_Report_EN.pdf. Accessed Jan 2016

  2. North American Pediatric Renal Trials and Cooperative Studies (NAPRTCS) (2011) Annual report. Available at: https://web.emmes.com/study/ped/annlrept/annualrept2011.pdf. Accessed Jan 2016

  3. Ferguson TW, Tangri N, Rigatto C, Komenda P (2015) Cost-effective treatment modalities for reducing morbidity associated with chronic kidney disease. Expert Rev Pharmacoecon Outcomes Res 15:243–252

    Article  PubMed  Google Scholar 

  4. Klarenbach SW, Tonelli M, Chui B, Manns BJ (2014) Economic evaluation of dialysis therapies. Nat Rev Nephrol 10:644–652

    Article  PubMed  Google Scholar 

  5. Hayes WN, Watson AR, Callaghan N, Wright E, Stefanidis CJ, European Pediatric Dialysis Working Group (2012) Vascular access: choice and complications in European paediatric haemodialysis units. Pediatr Nephrol 27:999–1004

    Article  PubMed  Google Scholar 

  6. Fadrowski JJ, Hwang W, Frankenfield DL, Fivush BA, Neu AM, Furth SL (2006) Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the clinical performance measures and US renal data system projects. Clin J Am Soc Nephrol 1:987–992

    Article  PubMed  Google Scholar 

  7. National Kidney Foundation (2006) NKF KDOQI guidelines (2006) Clinical practice guidelines and clinical practice recommendations 2006 updates. http://www2.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide1.htm

  8. Watson AR, Gartland C, European Paediatric Peritoneal Dialysis Working Group (2001) Guidelines by an ad hoc European committee for elective chronic peritoneal dialysis in pediatric patients. Perit Dial Int 21:240–244

    CAS  PubMed  Google Scholar 

  9. Wright S, Klausner D, Baird B, Williams ME, Steinman T, Tang H, Ragasa R, Goldfarb-Rumyantzev AS (2010) Timing of dialysis initiation and survival in ESRD. Clin J Am Soc Nephrol 5:1828–1835

    Article  PubMed  PubMed Central  Google Scholar 

  10. Traynor JP, Simpson K, Geddes CC, Deighan CJ, Fox JG (2002) Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure. J Am Soc Nephrol 13:2125–2132

    Article  PubMed  Google Scholar 

  11. Sawhney S, Djurdjev O, Simpson K, Macleod A, Levin A (2009) Survival and dialysis initiation: comparing British Columbia and Scotland registries. Nephrol Dial Transplant 24:3186–3192

    Article  PubMed  Google Scholar 

  12. Evans M, Tettamanti G, Nyren O, Bellocco R, Fored CM, Elinder CG (2011) No survival benefit from early-start dialysis in a population-based, inception cohort study of Swedish patients with chronic kidney disease. J Intern Med 269:289–298

    Article  CAS  PubMed  Google Scholar 

  13. Scialla JJ, Liu J, Crews DC, Guo H, Bandeen-Roche K, Ephraim PL, Tangri N, Sozio SM, Shafi T, Miskulin DC, Michels WM, Jaar BG, Wu AW, Powe NR, Boulware LE, DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators (2014) An instrumental variable approach finds no associated harm or benefit with early dialysis initiation in the United States. Kidney Int 86:798–809

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Fraenkel MB, Harris A, Johnson DW, Kesselhut J, Li JJ, Luxton G, Pilmore A, Tiller DJ, Harris DC, Pollock CA, IDEAL Study (2010) A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 363:609–619

    Article  CAS  PubMed  Google Scholar 

  15. Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR, Klarenbach S, Quinn RR, Hiremath S, Ravani P, Sood MM, Moist LM, Canadian Society of Nephrology (2014) Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ 186:112–117

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rosansky SJ, Clark WF, Eggers P, Glassock RJ (2009) Initiation of dialysis at higher GFRs: is the apparent rising tide of early dialysis harmful or helpful? Kidney Int 76:257–261

    Article  PubMed  Google Scholar 

  17. UK Renal Registry (2006). UK Renal Registry report 2006. UK Renal Registry, Bristol. Available at: http://www.renalreg.com/downloads/publications/

  18. Fischbach M, Dheu C, Seuge L, Orfanos N (2009) Hemodialysis and nutritional status in children: malnutrition and cachexia. J Ren Nutr 19:91–94

    Article  CAS  PubMed  Google Scholar 

  19. 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  PubMed  Google Scholar 

  20. Tong A, Wong G, McTaggart S, Henning P, Mackie F, Carroll RP, Howard K, Craig JC (2013) Quality of life of young adults and adolescents with chronic kidney disease. J Pediatr 163:1179–1185

    Article  PubMed  Google Scholar 

  21. Kilis-Pstrusinska K, Medynska A, Chmielewska IB, Grenda R, Kluska-Jozwiak A, Leszczynska B, Niedomagala J, Olszak-Szot I, Miklaszewska M, Szczepanska M, Tkaczyk M, Urzykowska A, Wasilewska A, Zachwieja K, Zajaczkowska M, Ziolkowska H, Zagozdzon I, Zwolinska D (2013) Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: multicentre national study results. Qual Life Res 22:2889–2897

    Article  PubMed  PubMed Central  Google Scholar 

  22. Canadian Institute for Health Information (2009) Data quality study on the Canadian Organ Replacement Register. Canadian Institute for Health Information, Ottawa

  23. Moist LM, Fenton S, Kim JS, Gill JS, Ivis F, de Sa E, Wu J, Al-Jaishi AA, Sood MM, Klarenbach S, Hemmelgarn BR, Kappel JE (2014) Canadian organ replacement register (CORR): reflecting the past and embracing the future. Can J Kidney Health Dis 1:26

    Article  PubMed  PubMed Central  Google Scholar 

  24. Samuel SM, Tonelli MA, Foster BJ, Nettel-Aguirre A, Na Y, Williams R, Soo A, Hemmelgarn BR (2010) Overview of the canadian pediatric end-stage renal disease database. BMC Nephrol 11:21

    Article  PubMed  PubMed Central  Google Scholar 

  25. Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843

    Article  PubMed  Google Scholar 

  26. Sood MM, Manns B, Dart A, Hiebert B, Kappel J, Komenda P, Molzahn A, Naimark D, Nessim S, Rigatto C, Soroka S, Zappitelli M, Tangri N, Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) (2014) Variation in the level of eGFR at dialysis initiation across dialysis facilities and geographic regions. Clin J Am Soc Nephrol 9:1747–1756

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. McCusker FX, Teehan BP, Thorpe KE, Keshaviah PR, Churchill DN (1996) How much peritoneal dialysis is required for the maintenance of a good nutritional state? Canada-USA (CANUSA) peritoneal dialysis study group. Kidney Int Suppl 56:S56–S61

    CAS  PubMed  Google Scholar 

  28. Seikaly MG, Salhab N, Browne R (2005) Patterns and time of initiation of dialysis in US children. Pediatr Nephrol 20:982–988

    Article  PubMed  Google Scholar 

  29. van Stralen KJ, Tizard EJ, Jager KJ, Schaefer F, Vondrak K, Groothoff JW, Podracka L, Holmberg C, Jankauskiene A, Lewis MA, van Damme-Lombaerts R, Mota C, Niaudet P, Novljan G, Peco-Antic A, Sahpazova E, Toots U, Verrina E (2010) Determinants of eGFR at start of renal replacement therapy in paediatric patients. Nephrol Dial Transplant 25:3325–3332

    Article  PubMed  Google Scholar 

  30. Vincenty T (1975) Direct and inverse solutions of geodesics on the ellipsoid with application of nested equations. Surv Rev XXII 176:88–93

    Article  Google Scholar 

  31. Atkinson MA, Oberai PC, Neu AM, Fivush BA, Parekh RS (2010) Predictors and consequences of higher estimated glomerular filtration rate at dialysis initiation. Pediatr Nephrol 25:1153–1161

    Article  PubMed  Google Scholar 

  32. Tromp WF, Schoenmaker NJ, van der Lee JH, Adams B, Bouts AH, Collard L, Cransberg K, Van Damme-Lombaerts R, Godefroid N, van Hoeck K, Koster-Kamphuis L, Lilien MR, Raes A, Offringa M, Groothoff JW (2012) Important differences in management policies for children with end-stage renal disease in the Netherlands and Belgium—report from the RICH-Q study. Nephrol Dial Transplant 27:1984–1992

    Article  PubMed  Google Scholar 

  33. Manns B, Barrett B, Evans M, Garg A, Hemmelgarn B, Kappel J, Klarenbach S, Madore F, Parfrey P, Samuel S, Soroka S, Suri R, Tonelli M, Wald R, Walsh M, Zappitelli M, Canadian Kidney Knowledge Translation and Generation Network (2014) Establishing a national knowledge translation and generation network in kidney disease: the Canadian Kidney Knowledge Translation and Generation Network. Can J Kidney Health Dis 1:2

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kovacevic L, Reid CJ, Rigden SP (2003) Management of congenital nephrotic syndrome. Pediatr Nephrol 18:426–430

    Article  PubMed  Google Scholar 

  35. Mann BS, Manns BJ, Dart A, Kappel J, Molzahn A, Naimark D, Nessim SJ, Soroka S, Zappitelli M, Sood MM, Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) (2014) An assessment of dialysis provider’s attitudes towards timing of dialysis initiation in Canada. Can J Kidney Health Dis 1:3

    Article  PubMed  PubMed Central  Google Scholar 

  36. Saban J, Zappitelli M, Samuel S, Sood M, Alexander RT, Ericsson R, Kroeker K, Manns B, Dart AB (2016) Perceptions of pediatric nephrologists regarding timing of dialysis initiation in children in Canada. Can J Kidney Health Dis 1:3

    Google Scholar 

  37. Samuel SM, Tonelli MA, Foster BJ, Alexander RT, Nettel-Aguirre A, Soo A, Hemmelgarn BR, Pediatric Renal Outcomes Canada Group (2011) Survival in pediatric dialysis and transplant patients. Clin J Am Soc Nephrol 6:1094–1099

    Article  PubMed  PubMed Central  Google Scholar 

  38. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  39. Fadrowski JJ, Furth SL (2011) GFR estimation in children: questions and answers (and questions). Clin J Am Soc Nephrol 6:1810–1812

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Bob Williams, Frank Ivis from CORR, the Canadian Institutes of Health Research (CIHR) and the Children’s Hospital Research Institute of Manitoba for funding support. MMS is provided salary support by the Jindal Research Chair for the Prevention of Kidney Disease at the University of Ottawa. SS has been provided funding from the Canadian Child Health Clinician Scientist Program. SS and MZ receive funding from the Kidney Foundation of Canada KRESCENT New Investigator program.

Author contributions

AD developed the initial study proposal and wrote the initial manuscript. SS, MZ, MMS, RTA, SA, and RE contributed to the study design, interpretation of the results and reviewed/edited the manuscript. KK and AS performed the analyses and reviewed/edited the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics and Child Health, Section of Nephrology and Children’s Hospital Research Institute of Manitoba, University of Manitoba, FE009–840 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1S1

    Allison B. Dart & Kristine Kroeker

  2. McGill University, Montreal, Quebec, Canada

    Michael Zappitelli

  3. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

    Manish M. Sood

  4. University of Alberta, Edmonton, Alberta, Canada

    R. Todd Alexander

  5. McMaster University, Ontario, Canada

    Steven Arora

  6. University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Robin L. Erickson

  7. University of Calgary, Calgary, Alberta, Canada

    Andrea Soo, Braden J. Manns & Susan M. Samuel

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Corresponding author

Correspondence to Allison B. Dart.

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Disclaimer

Parts of this material are based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not those of the Canadian Institute for Health Information.

Financial disclosure

MMS has been on advisory boards for Roche and Amgen and received speaking honoraria from Roche, Amgen and Sanofi. BM has partial funding of an investigator initiated grant from Merck and Baxter. The other authors have no conflicts of interest.

Ethics statement

Ethics approval to perform this study was obtained from the University of Manitoba and the University of Calgary.

Support

Canadian Organ Replacement Register (CORR), the Canadian Institutes of Health Research (CIHR), and the Children’s Hospital Research Institute of Manitoba (CHRIM)

Additional information

Allison B. Dart, Michael Zappitelli, Manish M. Sood, R. Todd Alexander, Steven Arora, Robin L. Erickson, Braden J. Manns and Susan M. Samuel are members of the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET)

This work was presented as an abstract and oral presentation at the American Society of Nephrology Renal Week 2013

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Dart, A.B., Zappitelli, M., Sood, M.M. et al. Variation in estimated glomerular filtration rate at dialysis initiation in children. Pediatr Nephrol 32, 331–340 (2017). https://doi.org/10.1007/s00467-016-3483-5

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  • DOI: https://doi.org/10.1007/s00467-016-3483-5

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