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Mortality trends in pediatric patients with chronic renal failure
U Reiss1, A M Wingen, K Schärer
1Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Insights
Mortality in pediatric chronic renal failure (CRF) patients decreased with renal replacement therapy (RRT) but remains persistent. Recent deaths are linked to congenital conditions, infections, and post-transplant cancers.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy Outcomes
- Chronic Renal Failure Epidemiology
Background:
- Chronic renal failure (CRF) presents significant mortality challenges in pediatric populations.
- Renal replacement therapy (RRT) has evolved over decades, impacting patient outcomes.
- Understanding long-term mortality trends is crucial for improving pediatric CRF care.
Purpose of the Study:
- To analyze mortality trends in children and adolescents with CRF over a 24-year period.
- To evaluate the impact of different RRT modalities on mortality rates.
- To identify primary causes of death in pediatric CRF patients, particularly those not receiving RRT.
Main Methods:
- Retrospective analysis of 441 pediatric patients with CRF over 24 years (pre- and post-RRT implementation).
- Calculation of mortality rates (MR) per 100 patient-years for different treatment periods and modalities.
- Analysis of causes of death, including reasons for non-acceptance of RRT.
Main Results:
- Overall MR decreased from 6.6 (1969-1978) to 2.5 (1979-1988), then slightly increased to 2.9 (1989-1992).
- Mortality reduction was observed across conservative treatment, hemodialysis (HD), continuous peritoneal dialysis (CPD), and transplantation (TX).
- An increase in MR post-TX was noted (1989-1992), primarily due to malignancies; infections and congenital multi-morbidities were key factors in non-RRT deaths.
Conclusions:
- Despite RRT advancements, pediatric CRF patients face persistent mortality.
- Congenital multi-morbidities hindering RRT feasibility, dialysis-related infections, and post-transplant malignancies are current major causes of death.
- Long-term strategies must address these specific challenges to further reduce pediatric CRF mortality.
Abstract:
Mortality trends were analyzed in 441 children and adolescents with chronic renal failure (CRF) observed over a 24-year period before and after institution of renal replacement therapy (RRT). A total of 93 patients died. Overall mortality rate (MR) per 100 patient years decreased from 6.6 in 1969-1978 to 2.5 in 1979-1988 and increased slightly to 2.9 in 1989-1992. The fall involved all four modes of treatment: conservative, hemodialysis (HD), continuous peritoneal dialysis (CPD), and transplantation (TX). From 1979-1988 to 1989-1992 MR on conservative and on dialysis treatment changed only slightly and was similar on HD and CPD. An alarming rise in MR was noted after TX in 1989-1992, mainly due to malignant tumors. In 44 patients who died on conservative treatment, the reasons for non-acceptance for RRT were analyzed: in 22 multi-morbidity was the main reason, usually because of a congenital neurological disorder. Some patients died from advanced uremia or unexpected events after the decision to institute RRT. Our experience demonstrates a persistent mortality in pediatric patients with CRF, which in recent years is primarily ascribed to congenital multi-morbid conditions which make RRT unfeasible, infections on dialysis treatment, and malignancies after TX.