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Renal replacement therapy for end-stage renal failure before 2 years of age
J H Ehrich1, G Rizzoni, F P Brunner
1Medizinische Hochschule, Hannover, Germany.
Insights
Pediatric end-stage renal failure (ESRF) treatment improved significantly, with better graft survival rates in children under two years old. Infections remain a key cause of death in these young patients undergoing renal replacement therapy (RRT).
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Organ Transplantation
Background:
- End-stage renal failure (ESRF) affects children globally, necessitating renal replacement therapy (RRT).
- The incidence of RRT initiation in children under 15 has shown an increasing trend, particularly in the youngest age group (under 2 years).
- Congenital anomalies like renal hypoplasia/dysplasia and hemolytic-uremic syndrome are primary causes of ESRF in early childhood.
Purpose of the Study:
- To analyze trends in RRT for pediatric end-stage renal failure.
- To evaluate the outcomes of renal transplantation in children, focusing on age at grafting.
- To identify causes of mortality in children undergoing RRT.
Main Methods:
- Retrospective analysis of 296 children from 24 countries initiating RRT between 1969 and 1988.
- Review of treatment modalities including continuous ambulatory peritoneal dialysis (CAPD), hemodialysis, and transplantation.
- Comparison of graft survival rates based on age at transplantation (under 2 years vs. over 2 years).
Main Results:
- Children under 2 years represented an increasing proportion of RRT initiations over time (8.9% in 1986-1988).
- One-year graft survival was 54% for children transplanted under 2 years and 65% for those over 2 years.
- Three-year patient survival improved from 65% (1978-1982) to 78% (1986-1988) for children under 2 years starting RRT.
Conclusions:
- Pediatric RRT has seen improvements, with better outcomes for younger children undergoing transplantation.
- Living donor grafts demonstrated excellent survival rates.
- Infections constitute a significant cause of death (23%) in this pediatric population.
Abstract:
This report concerns 296 children (67% males and 33% females) from 24 countries who started renal replacement therapy (RRT) for end-stage renal failure between 1969 and 1988. Children under 2 years of age represented 3.6%, 4.4%, and 8.9% of all children under 15 years of age who started RRT in 1978-1982, 1983-1985, and 1986-1988 respectively. During the first 2 years of life, the most frequent causes of end-stage renal failure were renal hypoplasia and dysplasia (24%), and haemolytic-uraemic syndrome (17%). During 1986-1988 the initial therapy for ESRF was continuous ambulatory peritoneal dialysis (CAPD) in 60%, haemodialysis 25%, intermittent peritoneal dialysis 8%, and 7% were transplanted without prior dialysis. Between 1978 and 1988, 139 of these children were grafted; 53 received a graft (39 cadaveric, 10 living donor, 4 donor uncertain) below, and 86 (71 cadaveric, 14 living donor, 1 donor uncertain) above 2 years of age. One-year graft survival was 54% in the 53 children grafted below 2 years of age and 65% in the 86 grafted above 2 years of age. Only two of the 24 living donor grafts were lost during the first year after grafting. These results compare favourably with the 67% 1-year graft survival of all 278 children aged 2 to less than 6 years at grafting in 1978-1988 on the Registry's file. The 3-year survival of all children aged less than 2 years at start of RRT was 65% in 1978-1982 and rose to 78% in 1986-1988. Twenty-three percent of all deaths were caused by infections.(ABSTRACT TRUNCATED AT 250 WORDS)