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Survival analysis among pediatric patients receiving kidney replacement therapy: a Japanese nationwide cohort study

Daishi Hirano1, Eisuke Inoue2, Mayumi Sako3

  • 1Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan. bqx1976@hotmail.com.

Pediatric Nephrology (Berlin, Germany)
|April 30, 2022
PubMed

Insights

Pediatric patients with chronic kidney disease (CKD) stage 5 on kidney replacement therapy (KRT) in Japan show high survival rates, but infants (<1 year) face significantly lower survival. Improvements in infant dialysis are needed.

Area of Science:

  • Nephrology
  • Pediatric Medicine
  • Public Health

Background:

  • Limited data exist on survival and causes of death for pediatric patients with chronic kidney disease (CKD) stage 5 undergoing kidney replacement therapy (KRT) in Asia.
  • This study addresses this gap by analyzing data from Japan.

Purpose of the Study:

  • To evaluate the survival rates and causes of death in pediatric patients (<20 years) with CKD stage 5 receiving KRT in Japan.
  • To identify factors influencing survival, particularly age at KRT initiation.

Main Methods:

  • A nationwide cross-sectional survey of pediatric patients starting KRT between 2006 and 2013 in Japan.
  • Cohort divided into age groups: <1 year, 1-5 years, and 6-19 years at KRT initiation.

Main Results:

  • Overall 1-year and 5-year survival rates were 97.2% and 92.5%, respectively, among 701 pediatric patients.
  • Infants (<1 year) had significantly lower survival rates (HR 5.35) compared to older children.
  • Infection (35.9%) and sudden death (15.4%) were the leading causes of mortality.

Conclusions:

  • Pediatric CKD stage 5 survival in Japan is comparable to other high-income countries.
  • Age at KRT initiation is a critical factor, with infants experiencing the poorest outcomes.
  • Enhanced dialysis strategies for infants are crucial to improve survival rates in the youngest pediatric population.
Abstract

Keywords:
ChildrenChronic kidney diseaseDialysisKidney replacement therapySurvival

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