Renal replacement therapy for children throughout the world: the need for a global registry (original) (raw)
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Pediatric Nephrology, 2010
Few data are available regarding the epidemiology of endstage renal disease (ESRD) in children. The European Society of Paediatric Nephrology (ESPN), in collaboration with the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), has recently established a meta-registry of European paediatric patient registries [1]. Thirty European countries reported individual patient data with information on date of birth, gender, start date renal replacement therapy (RRT), treatment modality at the start, changes in treatment, and important events such as The ESPN/ERA-EDTA registry study group consists of:
Clinical Kidney Journal
ABSTRACTBackgroundData on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT.MethodsWe included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression.ResultsComorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {ad...
Nephron
A total of 941 children and young people aged ,18 years with established renal failure (ERF) were receiving treatment at paediatric nephrology centres in 2015.. At the census date (31st December 2015), 75.3% of prevalent paediatric patients aged ,16 years had a functioning kidney transplant, 13.0% were receiving haemodialysis (HD) and 11.7% were receiving peritoneal dialysis (PD).. In patients aged ,16 years, prevalence of ERF was 62.7 per million age related population (pmarp) and incidence was 10.2 pmarp.. The most common primary renal diagnosis was renal dysplasia + reflux, present in 34.7% of prevalent paediatric patients aged ,16 years.. A quarter of patients aged ,16 years had one or more reported comorbidities at onset of renal replacement therapy (RRT).. Pre-emptive transplantation rates for children aged three months to 16 years who were referred early have been maintained and were 33.2% for the 2011-2015 period.. At transfer to adult services, 89.4% of patients had a functioning kidney transplant.. Survival during childhood among children commencing RRT was the lowest in those aged under two years compared to those aged 12 to ,16 years, with a hazard ratio of 4.1 (confidence interval [CI] 1.7-9.9) and in those receiving dialysis compared to having a functioning transplant, with a hazard ratio of 6.5 (CI 3.4-12.6).
Pediatric Nephrology, 2021
Background For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. Methods We included all children aged <15 years starting KRT 2007–2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. Results Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose...
Clinical Journal of the American Society of Nephrology, 2007
Design, setting, participants, and measurements: Ages were newborn to 25 yr, 58% were male, and weights were 1.3 to 160 kg. Patients spent a median of 2 d in the intensive care unit before CRRT (range 0 to 135). At CRRT initiation, 48% received diuretics and 66% received vasoactive drugs. Mean blood flow was 97.9 ml/min (range 10 to 350 ml/min; median 100 ml/min); mean blood flow per body weight was 5 ml/min per kg (range 0.6 to 53.6 ml/min per kg; median 4.1 ml/min per kg). Days on CRRT were <1 to 83 (mean 9.1; median 6). A total of 56% of circuits had citrate anticoagulation, 37% had heparin, and 7% had no anticoagulation.
The Scientific World Journal, 2014
A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI) and end stage kidney disease (ESKD) who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44%) patients required chronic dialysis program/ renal transplant, of which only 1 (9.1%) accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78%) of the patients belonged to the low socioeconomic class. Thirty-three (51.5%) could not access RRT because of financial constraints and discharge against medical advice (DAMA); 6 (9.4%) died on admission while sourcing for funds to access the therapy; 5 (7.8%) died while on RRT; 9 (14.1%) improved and were discharged for follow-up; 1 (1.6%) ...
Lancet (London, England), 2017
We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15·8 deaths per 1000 patient-years (IQR 6·4-16·4). France had a mortality rate (9·2) of more than 3 SDs ...
Nephron. Physiology, 2015
The Paediatric Registry analyses renal replacement therapy (RRT) data in children. All 13 UK paediatric nephrology centres submit electronic data. To provide centre specific data and to determine adherence to relevant audit standards. Data analysis to calculate summary statistics and achievement of an audit standard. The median height z-score for children on dialysis was -2.0 and for children with a functioning transplant -1.3. Children transplanted before age 11 years improved their height z score subsequently, whereas those >11 maintained their height z-score, with all transplanted patients having a similar height z-score after 3 years of starting RRT.The median weight z-score for children on dialysis was -1.2, and for children with a functioning transplant -0.2.Of those with data, 75% of the prevalent paediatric RRT population had .1 risk factors for cardiovascular disease, with 1 in 10 having all three risk factors evaluated. For transplant patients, 76% achieved the systolic...