Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Abstract

Background and objectives We evaluated rates and factors associating with late referral (LR) and describe association of LR with access to renal transplantation and patient survival in children in the United Kingdom. Early requirement of RRT within 90 days of presentation to a pediatric nephrologist was classed as a LR, and those .90 days as an early referral (ER).Design, setting, participants, & measurements We included patients who commenced RRT, aged $3 months and ,16 years, from 1996 to 2012.Results Of 1603 patients, 25.5% (n=408) were LR, of which 75% commenced RRT in ,30 days following presentation. Those with LR were more likely to be older at presentation, female, and black. The primary renal disease in LR was more likely to be glomerular disease (odds ratio [OR], 1.6; 95% confidence interval [95% CI], 1.12 to 2.29), renal malignancy and associated diseases (OR, 4.11; 95% CI, 1.57 to 10.72), tubulo-interstitial diseases (OR, 2.37; 95% CI, 1.49 to 3.78), or an uncertain renal etiology (OR, 5.75; 95% CI, 3.1 to 10.65). Significant differences in rates of transplantation between LR and ER remained up to 1-year following commencement of dialysis (21% versus 61%, P,0.001) but with no differences for donor source (33.3% and 35.3% living donor in LR and ER respectively, P=0.55). The median (interquartile range) follow-up time was 4.8 years (2.9-7.6). There were 55 deaths with no statistically significant difference in survival in the LR group compared with the ER group (hazard ratio, 1.30; 95% CI, 0.7 to 2.3; P=0.40).Conclusions We found that 25% of children starting RRT in the United Kingdom receive a LR to pediatric renal services, with little change observed over the past two decades. Those with LR are unable to benefit from preemptive transplantation and require longer periods of dialysis before transplantation. There is an urgent need to understand causes of avoidable LR and develop strategies to improve kidney awareness more widely among health care professionals looking after children.

The clinical epidemiology of young adults starting renal replacement therapy in the UK: presentation, management and survival using 15 years of UK Renal Registry data

“…Compared with adults in the UK in 2014, where 8.2% started RRT with a transplant and 20.0% started on PD, pre-emptive transplantation and PD rates are higher in young adults [ 21 ], perhaps due to PD being seen as more compatible with a young person’s lifestyle. A higher proportion (29.3%) of cases was known to have started dialysis within 90 days of the first nephrology review, compared with 25.5% of children from 1996 to 2012 [ 22 ] and 18.0% of UK adults in 2014 [ 21 ]. However, this is based on limited ‘first seen date’ data (50% completeness).…”

Renal replacement therapy and conservative management: NICE guideline (NG 107) October 2018

“…Overall, the guideline is a good attempt to simplify recommendations for commencing RRT in children with CKD. Data from the UK Renal registry (UKRR) highlights that approximately 25% of children with ESKD, need to commence dialysis after less than 3 months of seeing a paediatric nephrologist 11. More work is required on referral pathways to tertiary paediatric centres, which may help improve the outcomes of children with CKD.…”

The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis

“…Group two (8 studies): First presentation in kidney failure and/or requirement for KRT within specified time-frame (denominator: Incident kidney failure population) [11,[58][59][60][61][62][63][64] Group 2 studies included 3,567 participants with a median sample size of 146 (IQR 50-779, Table 3). Compared with group 1, group 2 studies were more likely to come from high-income countries (HIC, p = 0.01); half were multi-centre in design with data from 5 studies (62.5%) obtained from a registry dataset.…”