Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA

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Raphael Schild1, Simeon Dupont1, Jérôme Harambat2

  • 1Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Clinical Kidney Journal
|April 3, 2023
PubMed

Insights

Comorbidities are increasingly common in children undergoing kidney replacement therapy (KRT), negatively impacting their transplant access and survival, particularly for those on dialysis. Addressing these comorbidities is crucial for improving outcomes in pediatric kidney patients.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Comorbidity Research

Background:

  • Limited data exists on comorbidities in children receiving kidney replacement therapy (KRT).
  • Comorbidities significantly influence prognosis and treatment strategies in pediatric kidney disease.
  • This study addresses the scarcity of information by analyzing comorbidity prevalence and impact in European children on KRT.

Purpose of the Study:

  • To determine the prevalence of comorbidities in European children starting KRT.
  • To investigate the impact of comorbidities on kidney transplantation (KT) access and patient survival.
  • To analyze differences in comorbidity prevalence and outcomes based on country income levels.

Main Methods:

  • Retrospective analysis of data from 4127 children (<20 years) commencing KRT between 2007-2017.
  • Data sourced from the European Society of Paediatric Nephrology/European Renal Association Registry across 22 European countries.
  • Cox regression models used to compare KT access, patient survival, and graft survival between children with and without comorbidities.

Main Results:

  • Comorbidities were present in 33% of children starting KRT, with an annual prevalence increase of 5%.
  • Children with comorbidities had reduced KT access (aHR 0.67) and increased mortality risk (aHR 1.79), especially those on dialysis.
  • The impact of comorbidities on mortality was more pronounced in low-income countries; graft survival was unaffected.

Conclusions:

  • Comorbidities are increasingly prevalent in pediatric KRT patients, hindering transplant access and survival.
  • Kidney transplantation should be prioritized for all pediatric KRT patients, including those with comorbidities.
  • Identifying and addressing modifiable barriers to KT for children with comorbidities is essential.
Abstract

Keywords:
childrenchronic kidney diseasecomorbiditiesepidemiologykidney transplantation

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