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Pediatric dialysis and renal transplantation in Kuwait over the past 11 years
K El-Reshaid1, M M Kapoor, M R Nampoory
1Department of Medicine, Faculty of Medicine, Kuwait University, Safat.
Insights
Pediatric end-stage renal disease (ESRD) incidence in Kuwait was 18 per million children, with glomerulonephritis as the leading cause. Kidney transplantation offered better survival rates than dialysis for children requiring renal replacement therapy (RRT).
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Epidemiology
Background:
- End-stage renal disease (ESRD) in children presents unique challenges in diagnosis and management.
- Understanding the incidence, causes, and treatment outcomes of pediatric ESRD is crucial for public health planning.
- Limited data exists on pediatric ESRD and renal replacement therapy (RRT) in the Middle East region.
Purpose of the Study:
- To determine the incidence and etiology of pediatric ESRD in Kuwait.
- To evaluate the outcomes of different RRT modalities, including dialysis and kidney transplantation.
- To provide the first nationwide, long-term data on pediatric ESRD in a country with established treatment facilities.
Main Methods:
- Retrospective data collection from Kuwaiti dialysis centers, pediatric urology, and transplant units.
- Study period: January 1, 1986, to December 31, 1996 (11 years).
- Inclusion criteria: Children requiring RRT for ESRD; data analysis included incidence rates, causes, dialysis survival, and transplant outcomes.
Main Results:
- An average annual incidence rate of 18 per million Kuwaiti children was observed.
- Glomerulonephritis (44%) and pyelonephritis/urinary tract anomalies (30%) were the most common causes of pediatric ESRD.
- Actuarial survival on dialysis was 75% at 12 months, with higher mortality in children <6 years old. Kidney transplant survival at 12 months was 90% for live donor and 85% for cadaveric recipients, with graft survival rates of 76% and 66%, respectively.
Conclusions:
- Pediatric ESRD in Kuwait is primarily caused by glomerulonephritis and pyelonephritis.
- Kidney transplantation demonstrates superior patient and graft survival compared to dialysis for pediatric ESRD.
- This study provides essential epidemiological data and treatment outcome analysis for pediatric ESRD management in the region.
Abstract:
Data on end-stage renal disease (ESRD) patients and their renal replacement therapy (RRT) were collected retrospectively from the three dialysis centers, the pediatric urology unit, and the organ transplant center of Kuwait. The study period was from 1 January 1986 to 31 December 1996. A total of 61 children, 50 of whom were Kuwaiti nationals, required RRT for ESRD during those 11 years. This gave an average annual incidence rate of 18 per million Kuwaiti children. Glomerulonephritis was the most-frequent underlying disease and accounted for 44% of total cases, while pyelonephritis (including urinary tract anomalies and dysplastic kidneys) was responsible for 30%. Multisystem disease was responsible for ESRD in 7 patients (14%), 2 of whom had lupus nephritis, 2 vasculitis, 2 Henoch-Schönlein purpura, and 1 hemolytic uremic syndrome. Continuous ambulatory peritoneal dialysis and home intermittent peritoneal dialysis, using cycler machines, were not favored dialysis techniques by most parents, especially for those <6 years old. The actuarial survival on dialysis was 75%+/-7% at 12 months. Of the 8 patients who died, 7 were <6 years old. Thirty-eight patients received 46 kidney transplants, 13 of which were performed on a pre-emptive basis. The actuarial patient survivals at 12 months for those receiving first live and cadaveric kidney transplants were 90%+/-5% and 85%+/-2%, respectively, while those for grafts were 76%+/-8% and 66%+/-2%, respectively. This is the first nationwide long-term study of the incidence and etiology of pediatric ESRD in our area and the RRT in a country with adequate treatment facilities.