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Changing pattern of chronic renal failure and renal replacement therapy in children and adolescents: a 20-year single
Insights
Pediatric chronic renal failure treatment improved significantly between 1969 and 1988. Renal replacement therapy (RRT) survival rates increased, with better outcomes for younger children and adolescents receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Chronic Kidney Disease
Background:
- Analyzed demographic data, clinical course, and survival of 374 children and adolescents with chronic renal failure from 1969-1988.
- Observed trends across four subsequent 5-year periods to identify changes in patient populations and treatment outcomes.
Purpose of the Study:
- To evaluate the evolution of renal replacement therapy (RRT) in pediatric chronic renal failure over two decades.
- To compare survival rates and treatment modalities, including hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), and transplantation.
Main Methods:
- Retrospective analysis of 374 pediatric patients with chronic renal failure.
- Comparison of data across four 5-year intervals (1969-1988).
- Assessment of demographic shifts, disease incidence, RRT utilization, transplant waiting times, and patient survival.
Main Results:
- Proportion of patients under 5 years increased from 21% to 47%.
- Glomerulonephritis incidence rose, while pyelonephritis decreased; RRT use expanded to younger age groups.
- Overall 10-year survival on RRT reached 77%; 2-year survival was 100% for HD and CAPD in the last period.
- First cadaver graft survival improved from 25% to 69% over the study period.
Conclusions:
- Significant advancements in pediatric chronic renal failure management occurred between 1969 and 1988.
- Improved survival rates and graft success highlight the efficacy of evolving RRT strategies in children and adolescents.
- Increased RRT accessibility benefited younger patients and those with specific renal pathologies.
Abstract:
We analysed the demographic data, clinical course and survival on different forms of renal replacement therapy (RRT) of 374 children and adolescents with chronic renal failure observed between 1969 and 1988 and compared the findings for the four subsequent 5-year periods. The proportion of children below 5 years of age rose from 21% to 47%. With time the incidence of glomerulonephritis increased and that of pyelonephritis decreased. As RRT became more common, more very young children and more adolescents were admitted to the study. In the last 5 years continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD) were performed to the same extent as the initial form of RRT. The time a subject had to wait for a first transplant decreased from 36 to 21 months. Between 1969 and 1988 overall survival on any form of RRT increased to 77% after 10 years of therapy. In the last observation period 2-year patient survival was 100% both on HD and CAPD. First cadaver graft survival after 4 years improved from 25% in 1969-1973 to 69% in 1984-1988.