Long-term outcomes of children with end-stage renal disease

Area of Science:

• Pediatric Nephrology
• Cardiovascular Health in Chronic Disease
• Oncology in Renal Impairment

Background:

• Long-term survival for children with end-stage renal disease (ESRD) has improved, yet mortality rates remain high.
• Cardiovascular disease and infections are leading causes of death, accounting for up to 70% of mortality.
• Children with ESRD experience high rates of comorbidities, including left ventricular hypertrophy, vascular changes, metabolic bone disease, and a tenfold increased cancer risk.

Purpose of the Study:

• To review the long-term outcomes and comorbidities in children with end-stage renal disease.
• To identify mortality risk factors and prevalent morbidities in this population.
• To propose therapeutic targets for improving the health and survival of pediatric ESRD patients.

Main Methods:

• Review of existing literature on long-term survival, mortality causes, and comorbidities in pediatric end-stage renal disease.
• Analysis of risk factors including dialysis duration, renal transplantation status, and hypertension.
• Examination of the prevalence of cardiovascular disease, metabolic bone disease, infections, and malignancies.

Main Results:

• Cardiovascular disease (40-50%) and infections (20%) are primary causes of death.
• Prolonged dialysis and persistent hypertension are significant mortality risk factors.
• High prevalence of left ventricular hypertrophy (~50%), metabolic bone disease (~33%), and increased cancer risk (10x) observed in adult survivors.

Conclusions:

• Despite challenges, young adults with childhood-onset ESRD report positive health perceptions.
• Future research and therapy should prioritize preventing comorbidities like cardiovascular disease, infections, and malignancies.
• Strategies include early transplantation, optimized dialysis, rigorous hypertension management, and targeted pharmaceutical interventions.