Related Experiment Videos
Risk factors for mortality in infants and young children on dialysis
E G Wood1, M Hand, D M Briscoe
1Department of Pediatrics, Division of Pediatric Nephrology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St Louis, MO, USA. woodeg@slu.edu
Insights
Identifying risk factors for mortality in young children on dialysis is crucial. Younger age at dialysis initiation, nonrenal comorbidities like pulmonary disease, and oliguria/anuria in very young children are key mortality risk factors.
Area of Science:
- Pediatric Nephrology
- Clinical Pediatrics
- Renal Medicine
Background:
- Mortality risk factors in infants and young children undergoing dialysis are not well-defined.
- Early identification of these factors is essential for improving outcomes.
Purpose of the Study:
- To assess risk factors for mortality in patients younger than 6 years at the start of dialysis.
- To identify specific clinical characteristics associated with increased mortality risk in this vulnerable population.
Main Methods:
- A matched case-control study using data from the North American Pediatric Renal Transplant Cooperative Study.
- Inclusion of 137 pediatric patients (51 nonsurvivors, 86 survivors) younger than 6 years at dialysis initiation.
- Data collection via questionnaires on patient demographics, primary renal disease, comorbidities, and clinical status.
Main Results:
- One-year survival rates improved with age at dialysis initiation (83% for <3 months, 89% for 3-23 months, 95% for 2-5 years).
- Nonsurvivors more frequently had comorbid nonrenal disease (74% vs. 55%), particularly pulmonary disease/hypoplasia (37.8% vs. 17.4%).
- Oliguria/anuria was more common in nonsurvivors younger than 2 years (70% vs. 41%); infection caused 29.4% of deaths.
Conclusions:
- Age at dialysis initiation is a significant factor influencing survival in young children.
- Presence of nonrenal disease, especially pulmonary issues, and oliguria/anuria in children under 2 are critical mortality risk factors.
- These findings aid in identifying high-risk pediatric dialysis patients for targeted interventions.
Abstract:
The factors associated with a greater mortality risk in infants and young children undergoing dialysis have not been clearly determined. We report the results of a North American Pediatric Renal Transplant Cooperative Study designed to assess risk factors in patients aged younger than 6 years at initiation of dialysis therapy. Sixty-four nonsurvivors were matched with 110 survivors for age at dialysis initiation, primary renal disease, and year of entry onto the database. Questionnaires on 137 patients (51 nonsurvivors, 86 survivors) were completed by participating centers. Seventy-five percent (103 of 137 patients) of the patients were aged younger than 2 years at dialysis initiation; 42% (58 of 137 patients) had renal aplasia, dysplasia, and/or hypoplasia or obstructive uropathy; 62% were boys; and 62% were white. One-year patient survival rates were 83% in infants beginning dialysis at younger than 3 months of age, 89% in 3- to 23-month-olds, and 95% in 2- to 5-year-olds (P = 0.001). Comorbid nonrenal disease occurred in 37 of 51 nonsurvivors (74%) versus 46 of 84 survivors (55%; P = 0.027). Nonsurvivors had pulmonary disease and/or hypoplasia more often (14 of 37 nonsurvivors; 37.8% versus 8 of 46 survivors; 17.4%; P = 0.04). Oliguria or anuria was present in 23 of 33 nonsurvivors (70%) aged younger than 2 years versus 26 of 64 survivors (41%; P = 0.007). Infection accounted for 15 of 51 deaths (29.4%). In summary, these results suggest that age at dialysis initiation; presence of nonrenal disease, particularly pulmonary disease and/or hypoplasia; and oliguria or anuria in children aged younger than 2 years are identifiable as risk factors for mortality in these young patients.