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Infants Requiring Maintenance Dialysis: Outcomes of Hemodialysis and Peritoneal Dialysis
Enrico Vidal1, Karlijn J van Stralen2, Nicholas C Chesnaye2
1Department of Women's and Children's Health, University-Hospital of Padova, Padova, Italy.
Insights
In infants with chronic kidney failure, peritoneal dialysis (PD) and hemodialysis (HD) showed similar patient survival and kidney transplant rates. However, HD patients had a higher risk of switching dialysis treatments.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Infant Health
Background:
- Clinical outcomes of different dialysis modalities in infants with chronic kidney failure are not well-established.
- Understanding the impact of dialysis type is crucial for managing pediatric chronic kidney disease.
Purpose of the Study:
- To compare patient survival, technique survival, and kidney transplantation rates between peritoneal dialysis (PD) and hemodialysis (HD) in infants.
- To identify factors influencing outcomes in infants undergoing dialysis.
Main Methods:
- A cohort study analyzing data from the ESPN/ERA-EDTA Registry.
- Included 1,063 infants (≤12 months) initiating dialysis between 1991-2013.
- Cox regression analysis compared outcomes between PD and HD, adjusting for covariates.
Main Results:
- Infants on PD more often had congenital anomalies of the kidney and urinary tract (CAKUT), while HD patients had more metabolic disorders.
- Mortality risk and transplantation likelihood were similar for PD and HD.
- Hemodialysis patients had a significantly higher risk of switching dialysis treatment.
Conclusions:
- Patient survival and transplantation rates were comparable between PD and HD in infants.
- Despite preconceptions, HD is initiated in a notable proportion of infants in Europe.
- Higher risk of treatment change observed in infants on HD warrants further investigation.
Background:
The impact of different dialysis modalities on clinical outcomes has not been explored in young infants with chronic kidney failure.
Study Design:
Cohort study.
Setting & Participants:
Data were extracted from the ESPN/ERA-EDTA Registry. This analysis included 1,063 infants 12 months or younger who initiated dialysis therapy in 1991 to 2013.
Factor:
Type of dialysis modality.
Outcomes & Measurements:
Differences between infants treated with peritoneal dialysis (PD) or hemodialysis (HD) in patient survival, technique survival, and access to kidney transplantation were examined using Cox regression analysis while adjusting for age at dialysis therapy initiation, sex, underlying kidney disease, and country of residence.
Results:
917 infants initiated dialysis therapy on PD, and 146, on HD. Median age at dialysis therapy initiation was 4.5 (IQR, 0.7-7.9) months, and median body weight was 5.7 (IQR, 3.7-7.5) kg. Although the groups were homogeneous regarding age and sex, infants treated with PD more often had congenital anomalies of the kidney and urinary tract (CAKUT; 48% vs 27%), whereas those on HD therapy more frequently had metabolic disorders (12% vs 4%). Risk factors for death were younger age at dialysis therapy initiation (HR per each 1-month later initiation, 0.95; 95% CI, 0.90-0.97) and non-CAKUT cause of chronic kidney failure (HR, 1.49; 95% CI, 1.08-2.04). Mortality risk and likelihood of transplantation were equal in PD and HD patients, whereas HD patients had a higher risk for changing dialysis treatment (adjusted HR, 1.64; 95% CI, 1.17-2.31).
Limitations:
Inability to control for unmeasured confounders not included in the Registry database and missing data (ie, comorbid conditions). Low statistical power because of relatively small number of participants.
Conclusions:
Despite a widespread preconception that HD should be reserved for cases in which PD is not feasible, in Europe, we found 1 in 8 infants in need of maintenance dialysis to be initiated on HD therapy. Patient characteristics at dialysis therapy initiation, prospective survival, and time to transplantation were very similar for infants initiated on PD or HD therapy.
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