Late referral to paediatric renal failure service impairs access to pre-emptive kidney transplantation in children

Böehm, Michael; Winkelmayer, WC; Arbeiter, Klaus; Mueller, Thomas; Aufricht, Christoph

doi:10.1136/adc.2009.174581

Cited by 34 publications

(49 citation statements)

References 37 publications

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“…Unlike the recently published Austrian study, 25 we did not find that LR was associated with reduced pre‐emptive kidney transplantation rate or transplant rate in general. The overall rate of pre‐emptive transplants in Australia is less than that described in Boehm's European cohort 25 . Age at presentation and primary renal disease were the main factors determining whether children received pre‐emptive transplants.…”

Section: Discussioncontrasting

confidence: 99%

“…Two studies examined the effect of LR in children; a Polish multicentre study that showed children referred within 1 month of starting RRT had poorer clinical and biochemical status than those referred earlier, 14 and a single centre study from Austria showing reduced pre‐emptive transplantation (i.e. kidney transplantation without prior dialysis) rates in children referred within 12 months of RRT commencement 25 …”

mentioning

confidence: 99%

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Causes and outcome of late referral of children who develop end‐stage kidney disease

Kennedy

Bailey

Kainer

2011

J Paediatrics Child Health

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Causes and outcome of late referral of children who develop end‐stage kidney disease

Kennedy

Bailey

Kainer

2011

J Paediatrics Child Health

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“…To define LR in children, both time-interval-based definitions and those using level of renal dysfunction when first seen by a nephrologist have been reported (19)(20)(21). Our study findings are comparable to other pediatric reports at 21%-35% (19,25), although these studies have defined LR using a shorter time interval at #1 month between initial presentation and commencement of RRT.…”

Section: Discussionsupporting

confidence: 59%

“…LR will also delay listing for transplantation as work-up is delayed and reduce the chance of pre-emptive transplantation (16,17). Published data regarding the prevalence or impact of LR in children is scarce (18)(19)(20)(21); as are any United Kingdom-specific recommendations regarding optimal timing of referral for children with CKD to a pediatric nephrologist.…”

Section: Introductionmentioning

confidence: 99%

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

Pruthi

Casula

Inward

et al. 2016

CJASN

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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.

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“…Although kidney transplantation is considered to be the optimal mode of cRRT for children with ESRD, in most circumstances dialysis treatment as first cRRT is inevitable [9]. There is no consensus on the optimal mode of dialysis treatment.…”

Section: Discussionmentioning

confidence: 99%

Disparities in dialysis treatment and outcomes for Dutch and Belgian children with immigrant parents

et al. 2012

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BackgroundIn Belgium and the Netherlands, up to 40% of the children on dialysis are children with immigrant parents of non-Western European origin (non-Western). Concerns exist regarding whether these non-Western patients receive the same quality of care as children with parents of Western European origin (Western). We compared initial dialysis, post-initial treatment, and outcomes between non-Western and Western patients on dialysis.MethodsAll children <19 years old on chronic dialysis in the Netherlands and Belgium between September 2007 and May 2011 were included in the study. Non-Western patients were defined as children of whom one or both parents were born in non-Western countries.ResultsSeventy-nine of the 179 included patients (44%) were non-Western children. Compared to Western patients, non-Western patients more often were treated with hemodialysis (HD) instead of peritoneal dialysis (PD) as first dialysis mode (52 vs. 37%, p = 0.046). Before renal transplantation, non-Western patients were on dialysis for a median (range) of 30 (5–99) months, vs. 15 (0–66) months in Western patients (p = 0.007). Renal osteodystrophy was diagnosed in 34% of non-Western vs. 18% of Western patients (p = 0.028). The incidence rate ratio [95% confidence interval] for acute peritonitis was 2.44 [1.43-4.17] (p = 0.032) for non-Western compared to Western patients.ConclusionsThere are important disparities between children on chronic dialysis with parents from Western European origin and those from non-Western European origin in the choice of modality, duration, and outcomes of dialysis therapy.

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Late referral to paediatric renal failure service impairs access to pre-emptive kidney transplantation in children

Cited by 34 publications

References 37 publications

Causes and outcome of late referral of children who develop end‐stage kidney disease

Causes and outcome of late referral of children who develop end‐stage kidney disease

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

Disparities in dialysis treatment and outcomes for Dutch and Belgian children with immigrant parents

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