Comparative clinical outcomes between pediatric and young adult dialysis patients

Abstract

Published data on the comparative achievement of The Kidney Disease Dialysis Outcome Quality Initiative (KDOQI) recommended clinical performance targets between children and young adults on dialysis are scarce. To characterize the achievement of KDOQI targets among children (<18 years) and young adults (18-24 years) with prevalent end stage renal disease (ESRD), we performed a cross-sectional analysis of data collected by the Mid-Atlantic Renal Coalition, in conjunction with the 2007 and 2008 ESRD Clinical Performance Measures Projects. Data on all enrolled pediatric dialysis patients, categorized into three age groups (0-8, 9-12, 13-17 years), and on a random sample of 5% of patients ≥ 18 years in ESRD Network 5 were examined for two study periods: hemodialysis (HD) data were collected from October to December 2006 and from October to December 2007 and peritoneal dialysis (PD) data were collected from October 2006 to March 2007 and from October 2007 to March 2008. In total, 114 unique patients were enrolled the study, of whom 41.2% (47/114) were on HD and 58.8% (67/114) on PD. Compared to the pediatric patients, young adults were less likely to achieve the KDOQI recommended serum phosphorus levels and serum calcium × phosphorus product values, with less than one-quarter demonstrating values at or below each goal. Multivariate analysis revealed that both young adults and 13- to 17-year-olds were less likely to achieve target values for phosphorus [young adults: odds ratio (OR) 0.04, 95% confidence interval (95% CI) 0.01-0.19, p < 0.001; 13- to 17-year-olds: OR 0.17, 95% CI 0.04-0.77, p = 0.02] and calcium × phosphorus product (young adults: OR 0.01, 95% CI 0.002-0.09, p < 0.001; 13- to 17-year-olds: OR 0.09, 95% CI 0.02-0.56, p = 0.01) than younger children. In summary, there are significant differences in clinical indices between pediatric and young adult ESRD patients.

Does Statin Therapy Reduce the Risks of Mortality and Major Adverse Cardiac and Cerebrovascular Events in Young Adults with End-Stage Renal Disease? Population-Based Cohort Study

“…Importantly, the influences of mineral and bone metabolism disorder, volume overload, and control of hypertension may outweigh the importance of LDL level and atherosclerosis. First, studies have proven that higher average serum phosphorus concentration and daily calcium intake in patients receiving dialysis are related to coronary artery calcification and coronary artery disease [ 10 , 31 ]. In young adults, the imbalance of serum calcium and phosphate may be more severe than in older patients because of possible noncompliance with diet restrictions [ 32 , 33 ].…”

“…Atkinson et al reported that fewer than one-quarter of young adults (age,18–24 years) could achieve the Kidney Disease Outcomes Quality Initiative (KDOQI)-recommended serum phosphorus and calcium levels [ 32 ]. Goodman et al highlighted that the prevalence of coronary artery calcification, as measured using electron beam computed tomography, was as high as 88% among young patients (age, 20–30 years) receiving dialysis [ 31 ]. Second, in the young ESRD population, fluid restriction is another critical concern, and previous studies have reported their large fluid reduction during dialysis compared with older populations [ 33 , 34 ].…”