Variation in estimated glomerular filtration rate at dialysis initiation in children

Area of Science:

• Pediatric Nephrology
• Renal Replacement Therapy
• Chronic Kidney Disease

Background:

• Limited data exists on the optimal timing for initiating dialysis in pediatric patients.
• Current practices and trends in dialysis initiation timing based on estimated glomerular filtration rate (eGFR) in Canadian children are not well-defined.

Purpose of the Study:

• To determine current practices and secular trends in the timing of dialysis initiation for children in Canada.
• To analyze dialysis initiation based on estimated glomerular filtration rate (eGFR) levels.

Main Methods:

• An observational study of incident chronic dialysis patients aged 21 years or younger in Canada (2001-2010).
• Patients were categorized into higher (eGFR ≥10.5 ml/min/1.73 m²) or lower (eGFR <10.5 ml/min/1.73 m²) eGFR groups using CKiD Schwartz eGFR.
• Examined differences by treatment facility and region, and analyzed secular trends.

Main Results:

• The median eGFR at dialysis initiation was 8.1 ml/min/1.73 m².
• 29% of pediatric patients started dialysis with an eGFR ≥10.5 ml/min/1.73 m².
• The proportion of children starting dialysis with a higher eGFR increased from 27.3% in 2001 to 35.4% in 2010 (p=0.04), with significant variation across treatment facilities (12-70%, p=0.0001).
• Female sex, genetic cause of end-stage kidney disease, and living ≥50 km from a treatment facility were associated with higher eGFR at initiation.

Conclusions:

• Approximately one-third of children initiated dialysis with an eGFR ≥10.5 ml/min/1.73 m².
• Significant practice variations exist regarding the timing of dialysis initiation among Canadian treatment facilities.
• More research is necessary to evaluate the clinical implications of this observed practice variation.