15 years of experience with renal replacement therapy in patients starting therapy before age 20

This study retrospectively evaluates the survival on renal replacement therapy among patients starting dialysis before their twentieth birthday. The cohort included all patients starting therapy from 1972 through August, 1987 at the University of Mississippi or Kidney Care, Inc. Fifty-five patients, median age 17 years, range 5-19 years, underwent 335 patient years of therapy. Nineteen initially received CAPD; 12 home hemodialysis, 2 were transplanted prior to dialysis, and the remaining 22 patients were entered into dialysis in a free standing facility. Thirty-one patients received a cadaveric transplant and four patients received a living related transplant. The median transplant survival was 1360 days. There were 10 patients on renal replacement therapy over 10 years and a survival plot projected a 70% survival at 10 years. Nine patients died. Three percent of the time on renal replacement therapy was spent hospitalized. Although the hospitalization rate is significant, the pediatric patient may be expected to have a long survival on renal replacement therapy.