Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period

Abstract

End-stage renal disease requiring renal replacement therapy (RRT) during the neonatal period is a very rare condition, and little information is available regarding long-term RRT and outcomes. To gain more information, we performed a collaborative study on patient characteristics and treatment outcomes in children who started RRT as neonates during their first month of life between 2000 and 2011 who were prospectively registered in the ESPN/ERA-EDTA, the IPPN (since 2007), the Japanese registry, or the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry. During the first month of life, 264 patients from 32 countries started RRT and were followed for a median of 29 months (interquartile range 11-60 months). Most neonates (242) started on peritoneal dialysis, 21 started on hemodialysis, and 1 patient with a transplant. The most important causes of renal failure were congenital anomalies of the kidney and urinary tract in 141, cystic kidneys in 35, and cortical necrosis in 30. Within 2 years after the start of RRT, 69 children changed dialysis modality and 53 received a renal transplant. After a median of 7 months, 45 children had died, mainly because of infection, resulting in an estimated 2-year survival of 81%, and 5-year survival of 76%. Growth retardation (63%), anemia (55%), and hypertension (57%) were still major problems after 2 years. Thus, relatively good medium-term patient survival may be achieved with RRT started during the neonatal period, but specific therapeutic challenges continue to exist in this age group.

Outcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life

“…End-stage renal disease (ESRD) occurs rarely among children ,1 year of age, but for these children its consequences are profound. [1][2][3][4][5] Even with the early initiation of maintenance dialysis therapy, these patients are at high risk for a variety of morbidities and mortality. [6][7][8] This is especially true for those who initiate dialysis during the neonatal period.…”

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

“…[7][8][9][10][11] A DP neste grupo é um processo desafiante, continuando o seu início a motivar questões médicas e éticas. 6,7,12, A incidência de complicações da técnica é mais elevada, sendo as peritonites e as infeções associadas ao cateter as mais frequentes. 2,9,11,13,14 A taxa de mortalidade abaixo dos dois anos é até 55 vezes mais elevada que noutras idades pediátricas, embora séries recentemente publicadas revelem uma mudança nesta tendência associada à melhoria nos cuidados.…”

“…2,9,11,13,14 A taxa de mortalidade abaixo dos dois anos é até 55 vezes mais elevada que noutras idades pediátricas, embora séries recentemente publicadas revelem uma mudança nesta tendência associada à melhoria nos cuidados. 2,8,11,12 A mortalidade associa-se, mais do que à técnica, à presença de comorbilidades como cardiopatia, hipoplasia pulmonar e perturbações do desenvolvimento psicomotor.…”

Día Mundial del Riñón 2016. Prevención del legado de la nefropatía, con enfoque en la niñez

“…Los datos recientes agrupados de registros de todo el mundo indican que la sobrevida es adecuada, incluso cuando se requiere diálisis desde el período neonatal. 2,17 El trasplante renal -el tratamiento renal sustitutivo preferente en los niños-suele ser adecuado a partir de los 12 meses de vida, con una excelente sobrevida del paciente y del aloinjerto, y crecimiento y desarrollo extraordinarios.…”