High Mortality in Pediatric ESRD, but Lower with Transplantation

The 1-year mortality rates for children and adolescents with ESRD remain high but are substantially lower for patients receiving a kidney transplant compared with those who continue to receive dialysis, reports a study in the American Journal of Nephrology.

Using the US Renal Data System database, the researchers created annual cohorts of period-prevalent pediatric (younger than 19 years) ESRD patients from 1995 to 2010. The cohorts averaged about 1200 maintenance hemodialysis patients—60 percent using hemodialysis and 40 percent using peritoneal dialysis—and 1100 transplant recipients. Trends and patterns in 1-year mortality were assessed, including the effects of type of treatment and age group.

About half of the patients were aged 15 to 18, and 55 percent were male. Congenital, reflux, or obstructive causes of ESRD were present in 55 percent of patients and glomerulonephritis in 30 percent.

The unadjusted 1-year mortality per 100 patient-years was about 4.4 in dialysis patients, compared with 0.7 in transplant recipients. Except for a modest decline for peritoneal dialysis patients, the 1-year mortality rates did not consistently decline during the study period. On adjusted analysis, the odds of yearly survival were better for older patients, male patients, and those with glomerulonephritis as the cause of ESRD. Within yearly cohorts, race did not affect the odds of survival.

The 1-year mortality among children and adolescents with ESRD has not changed considerably since the 1990s. Mortality is about six times higher for dialysis patients than for transplant recipients. Efforts to reduce mortality from pediatric ESRD will require further improvement in dialysis procedures, early transplantation, and management of cardiovascular disease [Chavers BM, et al. One-year mortality rates in US children with end-stage renal disease Am J Nephrol 2015; 41:121–128].