Modality of renal replacement therapy and survival in the population of children with end-stage renal disease

Abstract

Background. Survival in the population of children with end-stage renal disease is multifactorial and depends on the diffe­rent characteristics of the patient and treatment, as well as on the degree of economic well-being of the country in which the treatment is taking place. While other patient-related aspects, such as growth, psychosocial development and quality of life, are important, extending patient survival is perhaps the most important clinical task. The aim of the study was to analyze the modality of renal replacement therapy and survival in the population of children with end-stage renal disease, based on a database of children in Kyiv who received renal replacement therapy from 2006 to 2018, using the example of the Kyiv Municipal Children’s Nephrology Centre. Materials and methods. In 40 children with chronic kidney disease stage 5 who received renal replacement therapy, modality of renal replacement therapy methods, primary renal diseases, gender and age characteristics, anthropometric data, glomerular filtration rate at the beginning of renal replacement therapy, residual kidney function, comorbidity and their effect on patients’ survival were analyzed. Results. Among 40 patients who started renal replacement therapy from 2006 to 2018 in Kyiv Municipal Children’s Nephro­logy Centre, the modality at baseline is represented by hemodialysis in 80 %, by preemptive kidney transplantation — in 12.5 %, by peritoneal dialysis — in 7.5 % of cases. The duration of renal replacement therapy ranged from 28 to 199 months. The majority of patients began treatment with hemodialysis at the age of 10–14 years (42.9 %). Kidney transplantation in children mainly occurred in 15–17 years (33.3 %). In total, the number of female patients on renal replacement therapy (hemodialysis and peritoneal dialysis) was 57.1 %, and that of men — 42.9 %. Among the patients with a transplanted kidney, 66.7 % are females and 33.3 % are males. In the majority of patients (> 50 %), primary renal diseases are represented by congenital anomalies of the kidney and the urinary tract; 10 % of children on renal replacement therapy had multiple congenital malformations (of the brain, heart, lungs), the syndromic diagnosis was recorded in 7.5 % of patients. Delayed psychomotor development was noted in 12.5 % of patients. Analysis of the obtained results showed that 48.6 % of children on hemodialysis and peritoneal dialysis were stunted, 51.4 % had arterial hypertension. With a glomerular filtration rate in the range of 8–15 ml/min/1.73 m2, 55 % of patients started treatment with renal replacement therapy. Conclusions. Survival of patients with end-stage renal disease is multifactorial, largely depends on access to treatment, health care costs in the country, etiology of the disease, age, sex, anthropometric parameters, the possibility of transplantation and the presence of concomitant diseases. Five-year survival rate of patients on renal replacement therapy for 2006–2018 in Kyiv Municipal Children’s Nephrology Centre was 93.1 %, 10-year survival rate — 83.3 %.

Keywords

• renal replacement therapy
• children
• survival