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Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric Peritoneal Dialysis Network Registry

Ploos van Amstel S 1 , Noordzij M 2 , Borzych-Duzalka D 3 , Chesnaye NC 1 , Xu H 4 , Rees L 5 Show all authors , Ha IS 6 , Antonio ZL 7 , Hooman N 8 , Wong W 9 , Vondrak K 10 , Yap YC 11 , Patel H 12 , Szczepanska M 13 , Testa S 14 , Galanti M 15 , Kari JA 16 , Samaille C 17 , Bakkaloglu SA 18 , Lai WM 19 , Rojas LF 20 , Diaz MS 21 , Basu B 22 , Neu A 23 , Warady BA 24 , Jager KJ 1 , Schaefer F 25

Affiliations 

  • 1 IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
  • 2 IPNA Global RRT Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. Electronic address: [email protected]
  • 3 Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany; Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
  • 4 Children's Hospital of Fudan University, Shanghai, People's Republic of China
  • 5 Great Ormond Street Hospital, London, United Kingdom
  • 6 Pediatrics Seoul, National University Children's Hospital, Seoul, South Korea
  • 7 Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
  • 8 Aliasghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
  • 9 Starship Children's Hospital, Auckland, New Zealand
  • 10 University Hospital Motol, Prague, Czech Republic
  • 11 Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
  • 12 Nationwide Children's Hospital, Columbus, OH
  • 13 Department of Pediatrics, Faculty of Medical Sciences, Zabrze, Medical University of Silesia, Katowice, Poland
  • 14 Fondazione Ospedale Maggiore Policlinico, Milan, Italy
  • 15 Roberto del Río Hospital, Santiago, Chile
  • 16 Pediatric Nephrology Center of Excellence, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • 17 Service de Néphrologie Pédiatrique, Hôpital Jeanne De Flandre, Lille, France
  • 18 Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey
  • 19 Department of Paediatric & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
  • 20 RTS, Medellin, Colombia
  • 21 Hospital Infantil de Nicaragua "Manuel de Jesus Rivera," Managua, Nicaragua
  • 22 NRS Medical College & Hospital, Kolkata, India
  • 23 School of Medicine, Johns Hopkins University, Baltimore, MD
  • 24 Children's Mercy, Kansas City, MO
  • 25 Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
Am J Kidney Dis, 2021 09;78(3):380-390.
PMID: 33549627 DOI: 10.1053/j.ajkd.2020.11.031

Abstract

RATIONALE & OBJECTIVE: Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors.

STUDY DESIGN: Prospective cohort study.

SETTING & PARTICIPANTS: Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017.

EXPOSURE: Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 income groups based on gross national income) factors also were studied.

OUTCOME: All-cause MPD mortality.

ANALYTICAL APPROACH: Patients were observed for 3 years, and the mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates.

RESULTS: A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After 3 years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%).

LIMITATIONS: The interpretation of interregional survival differences as found in this study may be hampered by selection bias.

CONCLUSIONS: This study shows that the overall 3-year patient survival on pediatric MPD is high, and that country income is associated with patient survival.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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