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Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric
Sophie Ploos van Amstel1, Marlies Noordzij1, Dagmara Borzych-Duzalka2
1IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Insights
Pediatric maintenance peritoneal dialysis (MPD) shows high survival rates globally. However, mortality risk in children on MPD is linked to country income, with lower-income nations experiencing higher rates.
Area of Science:
- Pediatric Nephrology
- Global Health
- Renal Replacement Therapy
Background:
- Kidney replacement therapy (KRT) research in children is concentrated in Europe and North America.
- Limited data exists on pediatric maintenance peritoneal dialysis (MPD) outcomes worldwide.
- Understanding global disparities in pediatric MPD is crucial for equitable care.
Purpose of the Study:
- To assess the mortality risk of children undergoing maintenance peritoneal dialysis (MPD) across diverse global regions.
- To identify demographic, clinical, and macroeconomic factors associated with pediatric MPD mortality.
- To investigate the influence of country income on survival rates in pediatric MPD patients.
Main Methods:
- Prospective cohort study involving 2,956 children initiating MPD between 1996 and 2017.
- Analysis of all-cause MPD mortality over a 3-year observation period.
- Statistical modeling to determine factors influencing mortality variation, including region and income level.
Main Results:
- Overall 3-year survival probability on pediatric MPD was high (95%).
- Mortality rates varied significantly by region, from 2% in North America to 9% in Eastern Europe.
- Lower-income countries exhibited higher MPD mortality rates compared to high-income countries, with income category explaining over 50% of regional variance.
Conclusions:
- Pediatric MPD demonstrates favorable 3-year survival rates globally.
- Country income level is a significant determinant of patient survival in pediatric MPD.
- Addressing socioeconomic factors is essential to reduce interregional disparities in pediatric KRT outcomes.
Rationale & Objective:
Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors.
Study Design:
Prospective cohort study.
Setting & Participants:
Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017.
Exposure:
Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 income groups based on gross national income) factors also were studied.
Outcome:
All-cause MPD mortality.
Analytical Approach:
Patients were observed for 3 years, and the mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates.
Results:
A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After 3 years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%).
Limitations:
The interpretation of interregional survival differences as found in this study may be hampered by selection bias.
Conclusions:
This study shows that the overall 3-year patient survival on pediatric MPD is high, and that country income is associated with patient survival.
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