Chapter 4 Demography of the UK Paediatric Renal Replacement Therapy Population in 2016

Plumb, Lucy; Wong, Esther; Casula, Anna; Braddon, Fiona; Lewis, Malcolm; Marks, Stephen D.; Shenoy, Mohan; Sinha, Manish D.; Maxwell, Heather

doi:10.1159/000490962

Cited by 15 publications

(14 citation statements)

References 5 publications

(5 reference statements)

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“…The UKRR collects data on all patients receiving KRT from UK adult and pediatric kidney units [ 15 , 16 ]. It has been granted a section 251 exemption by the Health Research Authority, allowing the registration of identifiable patient information from kidney units without first asking individual patient consent.…”

Section: Methodsmentioning

confidence: 99%

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

et al. 2020

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Background Although young adulthood is associated with transplant loss, many studies do not examine eGFR decline. We aimed to establish clinical risk factors to identify where early intervention might prevent subsequent adverse transplant outcomes. Methods Retrospective cohort study using UK Renal Registry and UK Transplant Registry data, including patients aged < 30 years transplanted 1998–2014. Associations with death-censored graft failure were investigated with multivariable Cox proportional hazards. Multivariable linear regression was used to establish associations with eGFR slope gradients calculated over the last 5 years of observation per individual. Results The cohort (n = 5121, of whom n = 371 received another transplant) was 61% male, 80% White and 36% had structural disease. Live donation occurred in 48%. There were 1371 graft failures and 145 deaths with a functioning graft over a 39,541-year risk period. Median follow-up was 7 years. Fifteen-year graft survival was 60.2% (95% CI 58.1, 62.3). Risk associations observed in both graft loss and eGFR decline analyses included female sex, glomerular diseases, Black ethnicity and young adulthood (15–19-year and 20–24-year age groups, compared to 25–29 years). A higher initial eGFR was associated with less risk of graft loss but faster eGFR decline. For each additional 10 mL/min/1.73m2 initial eGFR, the hazard ratio for graft loss was 0.82 (95% CI 0.79, 0.86), p < 0.0001. However, compared to < 60 mL/min/1.73m2, higher initial eGFR was associated with faster eGFR decline (> 90 mL/min/1.73m2; − 3.55 mL/min/1.73m2/year (95% CI -4.37, − 2.72), p < 0.0001). Conclusions In conclusion, young adulthood is a key risk factor for transplant loss and eGFR decline for UK children and young adults. This study has an extended follow-up period and confirms common risk associations for graft loss and eGFR decline, including female sex, Black ethnicity and glomerular diseases. A higher initial eGFR was associated with less risk of graft loss but faster rate of eGFR decline. Identification of children at risk of faster rate of eGFR decline may enable early intervention to prolong graft survival.

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Section: Methodsmentioning

confidence: 99%

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

et al. 2020

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“…For children with kidney failure, transplantation is the preferred KRT modality, offering superior patient survival, growth, and quality of life compared with dialysis during a crucial period of development (1)(2)(3). Furthermore, there is evidence that pre-emptive kidney transplantation is associated with lower risk of graft loss and death (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Despite recommendations, one in four children in the United Kingdom (UK) starting KRT currently receive a pre-emptive transplant. Patient characteristics associated with reduced access include female sex and non-White ethnicity (3,7,8). Timely transplant preparation is dependent on prompt detection of kidney disease; one common reason precluding pre-emptive transplantation is late presentation, defined as early requirement for dialysis after initial presentation to a nephrologist.…”

Section: Introductionmentioning

confidence: 99%

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Plumb

Sinha

Casula

et al. 2021

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Background and objectivesPre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation.Design, setting, participants, & measurementsA cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates.ResultsAnalysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2–9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model.ConclusionsSocioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.

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“…The incidence of CKD in children less than 16 years old in the UK was 9 per million of age-related population in 2016. A higher prevalence was noted in children from ethnic minorities, especially South Asian children in whom the prevalence was almost double the whole population estimate [3]. This observed difference is thought to be in part attributable to ethnic differences in rates of inherited kidney disease [4].…”

Section: Epidemiology Of Paediatric Chronic Kidney Diseasementioning

confidence: 92%

Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries?

et al. 2020

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The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease.

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Chapter 4 Demography of the UK Paediatric Renal Replacement Therapy Population in 2016

Cited by 15 publications

References 5 publications

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries?

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