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American Journal of Kidney DiseasesVolume 69, Issue 5, May 2017, Pages 617-625

Infants Requiring Maintenance Dialysis: Outcomes of Hemodialysis and Peritoneal Dialysis(Article)

  • Vidal, E.,
  • van Stralen, K.J.,
  • Chesnaye, N.C.,
  • Bonthuis, M.,
  • Holmberg, C.,
  • Zurowska, A.,
  • Trivelli, A.,
  • Da Silva, J.E.E.,
  • Herthelius, M.,
  • Adams, B.,
  • Bjerre, A.,
  • Jankauskiene, A.,
  • Miteva, P.,
  • Emirova, K.,
  • Bayazit, A.K.,
  • Mache, C.J.,
  • Sánchez-Moreno, A.,
  • Harambat, J.,
  • Groothoff, J.W.,
  • Jager, K.J.,
  • Schaefer, F.,
  • Verrina, E.,
  • Shtiza, D.,
  • Kramar, R.,
  • Oberbauer, R.,
  • Baiko, S.,
  • Sukalo, A.,
  • van Hoeck, K.,
  • Collart, F.,
  • des Grottes, J.M.,
  • Pokrajac, D.,
  • Roussinov, D.,
  • Batinić, D.,
  • Lemac, M.,
  • Slavicek, J.,
  • Seeman, T.,
  • Vondrak, K.,
  • Heaf, J.G.,
  • Toots, U.,
  • Finne, P.,
  • Grönhagen-Riska, C.,
  • Couchoud, C.,
  • Lasalle, M.,
  • Sahpazova, E.,
  • Abazi, N.,
  • Ristoka Bojkovska, N.,
  • von Gersdorff, G.,
  • Scholz, C.,
  • Tönshoff, B.,
  • Krupka, K.,
  • Höcker, B.,
  • Pape, L.,
  • Afentakis, N.,
  • Kapogiannis, A.,
  • Printza, N.,
  • Reusz, G.,
  • Berecki, C.S.,
  • Szabó, A.,
  • Szabó, T.,
  • Györke, Z.S.,
  • Kis, E.,
  • Palsson, R.,
  • Edvardsson, V.,
  • Gianoglio, B.,
  • Maringhini, S.,
  • Pecoraro, C.,
  • Picca, S.,
  • Testa, S.,
  • Rudaitis, S.,
  • Said-Conti, V.,
  • Gatcan, S.,
  • Berbeca, O.,
  • Zaikova, N.,
  • Pavićević, S.,
  • Leivestad, T.,
  • Zagozdzon, I.,
  • Mota, C.,
  • Almeida, M.,
  • Afonso, C.,
  • Mircescu, G.,
  • Garneata, L.,
  • Molchanova, E.A.,
  • Tomilina, N.A.,
  • Bikbov, B.T.,
  • Kostic, M.,
  • Peco-Antic, A.,
  • Spasojevic-Dimitrijeva, B.,
  • Milosevski-Lomic, G.,
  • Paripovic, D.,
  • Puric, S.,
  • Kruscic, D.,
  • Podracka, L.,
  • Kolvek, G.,
  • Buturovic-Ponikvar, J.,
  • Novljan, G.,
  • Battelino, N.,
  • Alonso Melgar, A.,
  • Schön, S.,
  • Prütz, K.G.,
  • Backmän, L.,
  • Stendahl, M.,
  • Evans, M.,
  • Rippe, B.,
  • Kuenhi, C.E.,
  • Maurer, E.,
  • Laube, G.F.,
  • Tschumi, S.,
  • Parvex, P.,
  • Hoitsma, A.,
  • Hemke, A.,
  • Topaloglu, R.,
  • Ivanov, D.,
  • Pruthi, R.,
  • Braddon, F.,
  • Mannings, S.,
  • Cassula, A.,
  • Sinha, M.D.,
  • Spanish Pediatric Registry,
  • Spanish Pediatric Registry,
  • Spanish Pediatric Registry
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  • aDepartment of Women's and Children's Health, University-Hospital of Padova, Padova, Italy
  • bESPN/ERA-EDTA Registry, Academic Medical Center, Amsterdam, Netherlands
  • cChildren's Hospital, Helsinki University Central Hospital, Helsinki, Finland
  • dDepartment of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
  • eDialysis Unit, IRCCS Giannina Gaslini, Genoa, Italy
  • fDepartamento da Criança e da Família, Hospital de Santa Maria, Lisboa, Portugal
  • gKarolinska Institutet–Karolinska University Hospital Huddinge, Stockholm, Sweden
  • hQueen Fabiola Children's University Hospital, Brussels, Belgium
  • iDepartment of Pediatrics, Oslo University Hospital-Rikshospitalet, Oslo, Norway
  • jVilnius University, Center for Pediatrics, Vilnius, Lithuania
  • kUniversity Hospital for Active Treatment of Pediatric Diseases, Sofia Medical University, Sofia, Bulgaria
  • lMoscow State University of Medicine and Dentistry, Moscow, Russian Federation
  • mDepartment of Pediatric Nephrology, Çukurova University, Adana, Turkey
  • nMedical University Graz, Graz, Austria
  • oHospital Infantil Universitario Virgen del Rocío, Sevilla, Spain
  • pDepartment of Pediatrics, Bordeaux University Hospital, Bordeaux, France
  • qDepartmnent of Pediatric Nephrology, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, Netherlands
  • rERA-EDTA Registry, Academic Medical Center, Amsterdam, Netherlands
  • sDivision of Pediatric Nephrology, University of Heidelberg, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany

Abstract

Background The impact of different dialysis modalities on clinical outcomes has not been explored in young infants with chronic kidney failure. Study Design Cohort study. Setting & Participants Data were extracted from the ESPN/ERA-EDTA Registry. This analysis included 1,063 infants 12 months or younger who initiated dialysis therapy in 1991 to 2013. Factor Type of dialysis modality. Outcomes & Measurements Differences between infants treated with peritoneal dialysis (PD) or hemodialysis (HD) in patient survival, technique survival, and access to kidney transplantation were examined using Cox regression analysis while adjusting for age at dialysis therapy initiation, sex, underlying kidney disease, and country of residence. Results 917 infants initiated dialysis therapy on PD, and 146, on HD. Median age at dialysis therapy initiation was 4.5 (IQR, 0.7-7.9) months, and median body weight was 5.7 (IQR, 3.7-7.5) kg. Although the groups were homogeneous regarding age and sex, infants treated with PD more often had congenital anomalies of the kidney and urinary tract (CAKUT; 48% vs 27%), whereas those on HD therapy more frequently had metabolic disorders (12% vs 4%). Risk factors for death were younger age at dialysis therapy initiation (HR per each 1-month later initiation, 0.95; 95% CI, 0.90-0.97) and non-CAKUT cause of chronic kidney failure (HR, 1.49; 95% CI, 1.08-2.04). Mortality risk and likelihood of transplantation were equal in PD and HD patients, whereas HD patients had a higher risk for changing dialysis treatment (adjusted HR, 1.64; 95% CI, 1.17-2.31). Limitations Inability to control for unmeasured confounders not included in the Registry database and missing data (ie, comorbid conditions). Low statistical power because of relatively small number of participants. Conclusions Despite a widespread preconception that HD should be reserved for cases in which PD is not feasible, in Europe, we found 1 in 8 infants in need of maintenance dialysis to be initiated on HD therapy. Patient characteristics at dialysis therapy initiation, prospective survival, and time to transplantation were very similar for infants initiated on PD or HD therapy. © 2016 National Kidney Foundation, Inc.

Author keywords

end-stage renal disease (ESRD)ESPN/ERA-EDTA RegistryEuropean Registery for Children on Renal Replacement Therapyhemodialysis (HD)infantmaintenance dialysisoutcomePediatric nephrologyperitoneal dialysis (PD)renal replacement therapy (RRT)RRT modalitysurvival

Indexed keywords

EMTREE drug terms:albuminbicarbonatecreatininehemoglobinparathyroid hormone
EMTREE medical terms:albumin blood levelArticlebleedingcardiovascular diseasecause of deathcerebrovascular accidentchronic kidney failureclinical outcomecreatinine blood levelfemaleglomerulonephritisheart infarctionhemodiafiltrationhemodialysishemoglobin blood levelhumaninfantinfectionkidney malformationkidney polycystic diseasekidney transplantationmajor clinical studymalemetabolic disordermortality riskparathyroid hormone blood levelperitoneal dialysisrespiratory failurerisk factorsudden cardiac deathsurvivaltime to treatmenturinary tract malformationvasculitisagecomparative studycomplicationEuropehealth care deliveryhemodialysishemolytic uremic syndromeischemiaKidney Failure, Chronicmortalitynewbornperitoneal dialysisproceduresproportional hazards modelregisterretrospective studystatistics and numerical datasurvival ratetime factortreatment outcomeurogenital tract malformation
MeSH:Age FactorsCause of DeathEuropeFemaleGlomerulonephritisHealth Services AccessibilityHemolytic-Uremic SyndromeHumansInfantInfant, NewbornIschemiaKidney Diseases, CysticKidney Failure, ChronicKidney TransplantationMaleMetabolic DiseasesMortalityPeritoneal DialysisProportional Hazards ModelsRegistriesRenal DialysisRetrospective StudiesSurvival RateTime FactorsTreatment OutcomeUrogenital AbnormalitiesVasculitis

Chemicals and CAS Registry Numbers:

bicarbonate, 144-55-8, 71-52-3; creatinine, 19230-81-0, 60-27-5; hemoglobin, 9008-02-0; parathyroid hormone, 12584-96-2, 68893-82-3, 9002-64-6

  • ISSN: 02726386
  • CODEN: AJKDD
  • Source Type: Journal
  • Original language: English
  • DOI: 10.1053/j.ajkd.2016.09.024
  • PubMed ID: 27955924
  • Document Type: Article
  • Publisher: W.B. Saunders

  Bonthuis, M.; ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, 1100 DE, Amsterdam, Netherlands;
© Copyright 2020 Elsevier B.V., All rights reserved.

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Sanderson, K.R. , Shih, W.V. , Warady, B.A.
Severe Fetal CAKUT (Congenital Anomalies of the Kidneys and Urinary Tract), Prenatal Consultations, and Initiation of Neonatal Dialysis
(2024) American Journal of Perinatology
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