Trends in chronic dialysis practices and outcomes in North American children: a 30-year NAPRTCS registry analysis

The North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry has tracked outcomes of children receiving maintenance dialysis since 1992.

We analyzed 8923 incident pediatric dialysis patients enrolled from 1992 to 2020, grouped into three eras (1992-2000, 2001-2010, 2011-2020). Demographics, primary diagnoses, dialysis modality, survival, causes of death, and time to kidney transplant were assessed.

The cohort was 56% male and 49% White. The most common causes of kidney failure were hypoplasia/dysplasia (15%), focal segmental glomerulosclerosis (14%), and obstructive uropathy (12%). Dialysis practices changed over time, with peritoneal dialysis (PD) declining as the initial modality from 66% in the 1990s to 40% in 2011-2020, while hemodialysis (HD) increased correspondingly. Infants represented an increasing proportion of patients initiating dialysis, rising from 15% in the 1990s to 25% in the most recent era. Three-year survival improved between the first and second eras to 90% but has remained stable in the past decade (91%). Infants had the lowest survival (77%). Among 734 deaths, cardiopulmonary causes remained stable across eras (22%), whereas infection-related mortality declined from 22 to 15% and occurred more frequently in PD than HD (23% vs. 12%, p < 0.05). 90% of children listed received a kidney transplant, and this was the most common cause of dialysis discontinuation.

Over time survival on dialysis has improved, though survival rates have recently been relatively static. Cardiopulmonary causes of death have not shown a decrease in prevalence across dialysis eras.