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Chisavu L, Mihaescu A, Bob F, Motofelea A, Schiller O, Marc L, Dragota-Pascota R, Chisavu F, Schiller A. Trends in mortality and comorbidities in hemodialysis patients between 2012 and 2017 in an East-European Country: a retrospective study. Int Urol Nephrol 2023; 55:2579-2587. [PMID: 36917413 PMCID: PMC10012315 DOI: 10.1007/s11255-023-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE The aim of this study was to evidence trends and changes in mortality, comorbid conditions, prognosis, and causes of death after 5 years of continuous evolution of hemodialysis (HD) patients in Romania. METHODS We included two cohorts of stable HD patients (901 from 2012 and 1396 from 2017). Both cohorts were followed up for 1 year. The 5-year survivors of the 2012 cohort were identified in 2017 and their data changes were assessed. RESULTS The 2017 patients were older, with longer time on dialysis, higher serum creatinine and urea levels, and required higher ultrafiltration volume per dialysis. They also had lower hemoglobin, lower C-reactive protein, higher albumin, higher calcium bicarbonate, and higher parathyroidectomy prevalence. The 2017 cohort presented with lower average dialysis flow, less administration of iron sucrose, had more catheters, lower hepatitis C prevalence, higher diabetes mellitus prevalence, higher heart valve calcifications, higher heart rate disorders, higher prevalence of left ventricular hypertrophy, and lower ejection fraction. Cardiovascular disease was the main cause of death in both years (50% in 2012 and 45.6% in 2017), followed by sepsis and cancer. The mortality was higher in 2017 compared to 2012 (14.1 vs 6.6%). The 5-year mortality was 37.2% with an average of 7.44%/year. The risk of death increased with age, higher C-reactive protein, higher phosphate, lower hemoglobin, and lower albumin. CONCLUSION Cardiovascular disease remains the main causes of death in HD-treated patients but with decreasing trend. Developing regional therapeutic strategies for quality care with early intervention will most likely improve mortality.
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Affiliation(s)
- Lazar Chisavu
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Avitum BBraun Dialysis Centre, Timisoara, Romania
| | - Adelina Mihaescu
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania.
- Emergency County Hospital "Pius Brinzeu" Timisoara, Timisoara, Romania.
| | - Flaviu Bob
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Emergency County Hospital "Pius Brinzeu" Timisoara, Timisoara, Romania
| | - Alexandru Motofelea
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Emergency City Hospital of Timisoara, Timisoara, Romania
| | | | - Luciana Marc
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Avitum BBraun Dialysis Centre, Timisoara, Romania
| | - Razvan Dragota-Pascota
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Emergency County Hospital "Pius Brinzeu" Timisoara, Timisoara, Romania
| | - Flavia Chisavu
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Emergency Hospital for Children "Louis Turcanu" Timisoara, Timisoara, Romania
| | - Adalbert Schiller
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
- Emergency County Hospital "Pius Brinzeu" Timisoara, Timisoara, Romania
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Bonthuis M, Vidal E, Bjerre A, Aydoğ Ö, Baiko S, Garneata L, Guzzo I, Heaf JG, Jahnukainen T, Lilien M, Mallett T, Mirescu G, Mochanova EA, Nüsken E, Rascher K, Roussinov D, Szczepanska M, Tsimaratos M, Varvara A, Verrina E, Veselinović B, Jager KJ, Harambat J. Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol 2021; 36:2337-2348. [PMID: 33483800 PMCID: PMC8260419 DOI: 10.1007/s00467-021-04928-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. METHODS We included all children aged <15 years starting KRT 2007-2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. RESULTS Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007-2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007-2009 or 2010-2012 (adjusted HR: 0.98, 95% CI:0.71-1.35). CONCLUSIONS We found a stable incidence and increasing prevalence of European children on KRT 2007-2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Anna Bjerre
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Özlem Aydoğ
- Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology "Dr Carol Davila" Teaching Hospital of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Isabella Guzzo
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Institute for Scientific Research, Bambino Gesù Children's Hospital, Rome, Italy
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marc Lilien
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Tamara Mallett
- Department of Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
- Department of Paediatric Nephrology, Royal Bristol Hospital for Children, Bristol, UK
| | - Gabriel Mirescu
- Department of Nephrology and Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Elena A Mochanova
- Department of Kidney Transplantation, Russian Children's Federal Clinical Hospital of Pirogov Russian National Research Medical University, Moscow, Russia
| | - Eva Nüsken
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katherine Rascher
- QiN-Group, Department of Medicine II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dimitar Roussinov
- SBAL Pediatric Diseases, Nephrology and Hemodialysis Clinic, Department of Pediatrics, Medical University of Sofia, 1606, Sofia, Bulgaria
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Askiti Varvara
- Nephrology Unit, Kyriakou Children's Hospital, Athens, Greece
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | | | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux, Bordeaux, France
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Logeman C, Guha C, Howell M, Hanson CS, Craig JC, Samuel S, Zappitelli M, Matsuda-Abedini M, Dart A, Furth S, Eddy A, Groothoff J, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Michael M, Walker A, Kausman J, Gaillard S, Bacchetta J, Rheault MN, Warady BA, Neu A, Christian M, McTaggart S, Liu I, Teo S, Sautenet B, Gutman T, Carter S, Teixeira-Pinto A, Tong A. Developing Consensus-Based Outcome Domains for Trials in Children and Adolescents With CKD: An International Delphi Survey. Am J Kidney Dis 2020; 76:533-545. [PMID: 32654889 DOI: 10.1053/j.ajkd.2020.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/08/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE & OBJECTIVE The inconsistency in outcomes reported and lack of patient-reported outcomes across trials in children with chronic kidney disease (CKD) limits shared decision making. As part of the Standardized Outcomes in Nephrology (SONG)-Kids initiative, we aimed to generate a consensus-based prioritized list of critically important outcomes to be reported in all trials in children with CKD. STUDY DESIGN An online 2-round Delphi survey in English, French, and Hindi languages. SETTINGS & PARTICIPANTS Patients (aged 8-21 years), caregivers/family, and health care professionals (HCPs) rated the importance of outcomes using a 9-point Likert scale (7-9 indicating critical importance) and completed a Best-Worst Scale. ANALYTICAL APPROACH We assessed the absolute and relative importance of outcomes. Comments were analyzed thematically. RESULTS 557 participants (72 [13%] patients, 132 [24%] caregivers, and 353 [63%] HCPs) from 48 countries completed round 1 and 312 (56%) participants (28 [40%] patients, 64 [46%] caregivers, and 220 [56%] HCPs) completed round 2. Five outcomes were common in the top 10 for each group: mortality, kidney function, life participation, blood pressure, and infection. Caregivers and HCPs rated cardiovascular disease higher than patients. Patients gave lower ratings to all outcomes compared with caregivers/HCPs except they rated life participation (round 2 mean difference, 0.1), academic performance (0.1), mobility (0.4), and ability to travel (0.4) higher than caregivers and rated ability to travel (0.4) higher than HCPs. We identified 3 themes: alleviating disease and treatment burden, focusing on the whole child, and resolving fluctuating and conflicting goals. LIMITATIONS Most participants completed the survey in English. CONCLUSIONS Mortality, life participation, kidney function, and blood pressure were consistently highly prioritized by patients, caregivers, and HCPs. Patients gave higher priority to some lifestyle-related outcomes compared with caregivers/HCPs. Establishing critically important outcomes for all trials in children with CKD may improve consistent reporting of survival, kidney health, and clinical and life impact outcomes that are meaningful for decision making.
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Affiliation(s)
- Charlotte Logeman
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, Canada
| | - Mina Matsuda-Abedini
- Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine, Philadelphia, PA; Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Department of Renal Medicine and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Debbie S Gipson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Mini Michael
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Amanda Walker
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Bron, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, Reference Center for Rare Renal Diseases, Hospices civils de Lyon, Lyon, France
| | - Michelle N Rheault
- Division of Nephrology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | | | - Alicia Neu
- Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Steven McTaggart
- Child and Adolescent Renal Service, Queensland Children's Hospital and University of Queensland, Brisbane, Australia
| | - Isaac Liu
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Sharon Teo
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Benedicte Sautenet
- Department of Nephrology Hypertension, dialysis, kidney transplantation, Tours Hospital, SPHERE - INSERM 1246, University of Tours and Nantes, Tours, France
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Simon Carter
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Galiyeva DB, Jackson CA, Wild SH, Burns S, Hughes D, Traynor JP, Metcalfe W, Halbesma N. Long-term all-cause mortality and cardiovascular outcomes in Scottish children after initiation of renal replacement therapy: a national cohort study. Pediatr Nephrol 2020; 35:677-685. [PMID: 31845058 PMCID: PMC7056691 DOI: 10.1007/s00467-019-04430-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on long-term outcomes in children who have received renal replacement therapy (RRT) for end-stage renal disease are limited. METHODS We studied long-term survival and incidence of fatal and nonfatal cardiovascular disease (CVD) events and determinants of these outcomes in children who initiated RRT between 1961 and 2013 using data from the Scottish Renal Registry (SRR). Linkage to morbidity records was available from 1981. RESULTS A total of 477 children of whom 55% were boys, almost 50% had congenital urinary tract disease (CAKUT), 10% received a transplant as the first mode of RRT and almost 60% were over 11 years of age at start of RRT were followed for a median of 17.8 years (interquartile range (IQR) 8.7-26.6 years). Survival was 87.3% (95% confidence interval (CI) 84.0-90.1) at 10 years and 77.6% (95% CI 73.3-81.7) at 20 years. During a median follow-up of 14.96 years (IQR 7.1-22.9), 20.9% of the 381 patients with morbidity data available had an incident of CVD event. Age < 2 years at start of RRT, receiving dialysis rather than a kidney transplant and primary renal disease (PRD) other than CAKUT or glomerulonephritis (GN), were associated with a higher risk of all-cause mortality. Male sex, receiving dialysis rather than a kidney transplant and PRD other than CAKUT or GN, was associated with a higher risk of CVD incidence. CONCLUSIONS Mortality and CVD incidence among children receiving RRT are high. PRD and RRT modality were associated with increased risk of both all-cause mortality and CVD incidence.
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Affiliation(s)
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Nynke Halbesma
- Usher Institute, University of Edinburgh, Edinburgh, UK.
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Groothoff JW, Offringa M, Grootenhuis M, Jager KJ. Long-term consequences of renal insufficiency in children: lessons learned from the Dutch LERIC study. Nephrol Dial Transplant 2019; 33:552-560. [PMID: 28992218 DOI: 10.1093/ndt/gfx190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/28/2017] [Indexed: 11/14/2022] Open
Abstract
Few data exist on the prospects in adulthood for children on chronic renal replacement therapy (RRT). This article summarizes the results of a comprehensive Dutch long-term follow-up study performed in 2000 and 2010 of patients with RRT onset at age <15 years between 1972 and 1992. After a median of 25.5 RRT years, patients had stayed 23% of RRT time on dialysis. We observed a 30 times greater mortality risk compared with age-matched peers with cardiovascular disease (CVD) as the main cause of death during 1972-2000 and infections during 2000-10. The observed shift towards infections was associated with more RRT time with a graft and receiving a stricter CVD protective treatment. For patients >40 years of age, motor disabilities affecting routine activities, skin cancer and severe fatigue were the most disabling sequelae. After 30 years of transplantation, 41% of the survivors had developed cancer, a life-threatening form of squamous cell skin carcinoma being most prevalent. Important delays in autonomy development and educational attainment and a relatively high level of unemployment were observed. Transplanted patients reported a good mental and physical quality of life, but the latter tended to decrease over time. A long period of dialysis was associated with all adverse somatic and psychosocial outcomes. Paediatric nephrologists should aim for transplantation at the earliest possible time and focus on autonomy and educational attainment. Nephrologists should focus on strict CVD prevention, adjustment of immunosuppression to the lowest possible dose and surveillance of malignancy-associated viral infections in patients with childhood end-stage renal disease.
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Affiliation(s)
- Jaap W Groothoff
- Department of Paediatric Nephrology, H7-234, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Martin Offringa
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martha Grootenhuis
- Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands
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Chesnaye NC, van Stralen KJ, Bonthuis M, Harambat J, Groothoff JW, Jager KJ. Survival in children requiring chronic renal replacement therapy. Pediatr Nephrol 2018; 33:585-594. [PMID: 28508132 PMCID: PMC5859702 DOI: 10.1007/s00467-017-3681-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 01/19/2023]
Abstract
Survival in the pediatric end-stage renal disease (ESRD) population has improved substantially over recent decades. Nonetheless, mortality remains at least 30 times higher than that of healthy peers. Patient survival is multifactorial and dependent on various patient and treatment characteristics and degree of economic welfare of the country in which a patient is treated. In this educational review, we aim to delineate current evidence regarding mortality risk in the pediatric ESRD population and provide pediatric nephrologists with up-to-date information required to counsel affected families.
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Affiliation(s)
- Nicholas C Chesnaye
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital and INSERM U1219, Bordeaux, France
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, Netherlands
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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7
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Hogan J, Pietrement C, Sellier-Leclerc AL, Louillet F, Salomon R, Macher MA, Berard E, Couchoud C. Infection-related hospitalizations after kidney transplantation in children: incidence, risk factors, and cost. Pediatr Nephrol 2017; 32:2331-2341. [PMID: 28744628 DOI: 10.1007/s00467-017-3737-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Infection is the leading cause of death and hospitalization in renal transplant recipients. We describe posttransplant infections requiring hospitalization, their risk factors and cost in a national pediatric kidney transplantation cohort. METHODS Data on renal transplant recipients <20 years were extracted from the French National Medicoadministrative Hospital Discharge database between 2008 and 2013 and matched with the Renal Transplant Database. We used Cox regression to study risk factors of hospitalization and calculated the instantaneous risk of hospitalization per month for all infections and by infection type. RESULTS Five hundred and ninety-three patients were included, and 660 infection-related hospitalizations were identified in 260 patients. The leading cause of hospitalization was urinary tract infection (UTI), followed by viral infection (16.6 and 15.6 per 100 person-years, respectively). Risk factors were younger age at transplantation, high number of HLA mismatches, and use cyclosporine rather than tacrolimus as first anticalcineurin treatment. Risk factors varied by infection type. Female gender, uropathy, cold ischemia time, and cyclosporine were associated with increased risk of UTI, while only age at transplantation inversely correlated with virus-related hospitalizations. Instantaneous risk of all infections decreased with time, except for cytomegalovirus (CMV) infection that displayed a peak at 6 months posttransplantation after prophylaxis withdrawal. Total cost of infection-related hospitalizations was 1600 kilo-euro (k€) (933 €/person-years). CONCLUSIONS This study highlights the high burden of infection in transplanted pediatric patients, especially the youngest. This should be considered both for pretransplantation information and designing procedures aiming to decrease hospitalization rate and duration.
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Affiliation(s)
- Julien Hogan
- Pediatric Nephrology Department, Hôpital Robert Debré, APHP, 48 bld Sérurier, 75019, Paris, France. .,Registre REIN, Agence de la Biomédecine, La Plaine Saint-Denis, France.
| | | | | | - Ferielle Louillet
- Pediatric Nephrology Department, Hôpital Charles Nicolle, Rouen, France
| | - Rémi Salomon
- Pediatric Nephrology Department, Hôpital Necker Enfants Malades, Paris, France
| | - Marie-Alice Macher
- Pediatric Nephrology Department, Hôpital Robert Debré, APHP, 48 bld Sérurier, 75019, Paris, France
| | - Etienne Berard
- Pediatric Nephrology Department, Fondation Lenval, Nice, France
| | - Cécile Couchoud
- Registre REIN, Agence de la Biomédecine, La Plaine Saint-Denis, France
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8
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Dobrowolski LC, van Huis M, van der Lee JH, Peters Sengers H, Liliën MR, Cransberg K, Cornelissen M, Bouts AH, de Fijter JW, Berger SP, van Zuilen A, Nurmohamed SA, Betjes MH, Hilbrands L, Hoitsma AJ, Bemelman FJ, Krediet P, Groothoff JW. Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands. Nephrol Dial Transplant 2016; 31:1947-1956. [DOI: 10.1093/ndt/gfw225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 12/16/2022] Open
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9
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Tjaden LA, Maurice-Stam H, Grootenhuis MA, Jager KJ, Groothoff JW. Impact of Renal Replacement Therapy in Childhood on Long-Term Socioprofessional Outcomes: A 30-year Follow-Up Study. J Pediatr 2016; 171:189-95.e1-2. [PMID: 26768838 DOI: 10.1016/j.jpeds.2015.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/06/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate socioprofessional outcomes after 30 years of renal replacement therapy (RRT) and explore predictors of these outcomes. STUDY DESIGN The cohort comprised all Dutch patients, born before 1979, who started RRT at age <15 years in 1972-1992. Outcomes including family life, educational attainment, and professional life were obtained in 2000 and 2010 in 80 out of 152 survivors. Participants also completed the Course of Life Questionnaire in 2000, which retrospectively assessed the achievement of developmental milestones while growing up. Socioprofessional outcomes in 2010 were compared with the age-matched general population and with outcomes obtained in 2000. Logistic regression analysis was performed to identify determinants of socioprofessional outcomes. RESULTS Mean age and time on RRT in 2010 were 40.6 years (range 32.1-52.4) and 28.9 years (range 18.1-39.7), respectively. Patients were less likely to be employed (62.5% vs 81.0%) and have children (28.8% vs 64.8%) compared with the age-matched general population. Comorbidities, dialysis, short stature, and fewer milestones on autonomy were associated with adverse outcomes. Compared with 2000, in 2010 more patients lived with a partner (68.8% vs 43.0%), and more patients had completed a high level educational degree (22.5% vs 13.9%). However, more patients were unable to work on medical grounds in 2010 (36.3% vs 16.3%). CONCLUSIONS Survivors of pediatric end-stage renal disease may gain social autonomy and optimal educational attainment at an older age compared with their general population counterparts. Awareness among health care professionals of the potential of these children and tailored psychosocial interventions might improve socioprofessional development.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Tjaden LA, Noordzij M, van Stralen KJ, Kuehni CE, Raes A, Cornelissen EA, O’Brien C, Papachristou F, Schaefer F, Groothoff JW, Jager KJ. Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association−European Dialysis and Transplant Association) Registry. Am J Kidney Dis 2016; 67:293-301. [DOI: 10.1053/j.ajkd.2015.09.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/19/2015] [Indexed: 11/11/2022]
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Lofaro D, Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age. Pediatr Nephrol 2016; 31:315-23. [PMID: 26463555 PMCID: PMC4689769 DOI: 10.1007/s00467-015-3209-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT. METHODS The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and 1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over noninfectious HAR ratio (HARR). RESULTS The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001). CONCLUSIONS Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.
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Affiliation(s)
- Danilo Lofaro
- />Kidney and Transplantation Research Centre, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy
| | - Judith L. Vogelzang
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J. Jager
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
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Sumida K, Yamagata K, Iseki K, Tsubakihara Y. Different impact of hemodialysis vintage on cause-specific mortality in long-term hemodialysis patients. Nephrol Dial Transplant 2015; 31:298-305. [PMID: 26666499 DOI: 10.1093/ndt/gfv402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/27/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although dialysis vintage is associated with increased mortality risk in patients receiving hemodialysis (HD), the association of dialysis vintage with cause-specific mortality is unclear. METHODS We conducted a nationwide registry-based retrospective cohort study of 216 246 patients receiving maintenance HD for > 1 year at the end of 2009. The associations of dialysis vintage categories (1 -< 2, 2 -< 5, 5 -< 10, 10 -< 15, 15 -< 20, 20 -< 25, 25 -< 30 and ≥ 30 years) with 1-year all-cause and cause-specific mortality, including cardiovascular diseases (CVDs) and infection-related mortality, were examined using logistic regression models. RESULTS During the 1-year study period, 18 614 deaths occurred from all causes, including 7263 and 3504 deaths from CVD and infection-related causes. From multivariate analysis, the dialysis vintage was incrementally associated with a higher risk for all-cause mortality, with worse outcome observed in the ≥ 30 years category {odds ratio [OR] = 2.43 (95% confidence interval (CI) 2.13-2.77}. A similar association was apparent between the dialysis vintage and infection-related mortality, with a higher risk than that of all-cause mortality in each vintage category [≥ 30 years, OR = 3.55 (95% CI 2.72-4.66)], while the dialysis vintage was associated with only a modest increase in risk of CVD mortality [≥ 30 years, OR = 1.64 (95% CI 1.30-2.08)]. CONCLUSIONS Dialysis vintage has a different impact on cause-specific mortality, with a higher risk for infection-related mortality than CVD mortality. This impact is most pronounced in long-term HD survivors, to whom much attention should be devoted to prevent infectious complications.
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Affiliation(s)
- Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kunihiro Yamagata
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Kunitoshi Iseki
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Yoshiharu Tsubakihara
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
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Pippias M, Jager KJ, Kramer A, Leivestad T, Sánchez MB, Caskey FJ, Collart F, Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG, Hemmelder MH, Kramar R, De Meester J, Noordzij M, Palsson R, Pascual J, Zurriaga O, Wanner C, Stel VS. The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry. Nephrol Dial Transplant 2015; 31:831-41. [PMID: 26361801 DOI: 10.1093/ndt/gfv327] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/10/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study examines the time trends in incidence, prevalence, patient and kidney allograft survival and causes of death (COD) in patients receiving renal replacement therapy (RRT) in Europe. METHODS Eighteen national or regional renal registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry between 1998 and 2011 were included. Incidence and prevalence time trends between 2001 and 2011 were studied with Joinpoint and Poisson regression. Patient and kidney allograft survival and COD between 1998 and 2011 were analysed using Kaplan-Meier and competing risk methods and Cox regression. RESULTS From 2001 to 2008, the adjusted incidence of RRT rose by 1.1% (95% CI: 0.6, 1.7) annually to 131 per million population (pmp). During 2008-2011, the adjusted incidence fell by 2.2% (95% CI: -4.2, -0.2) annually to 125 pmp. This decline occurred predominantly in patients aged 45-64 years, 65-74 years and in the primary renal diseases diabetes mellitus type 1 and 2, renovascular disease and glomerulonephritis. Between 2001 and 2011, the overall adjusted prevalence increased from 724 to 1032 pmp (+3.3% annually, 95% CI: 2.8, 3.8). The adjusted 5-year patient survival on RRT improved between 1998-2002 and 2003-2007 [adjusted hazard ratio (HRa) 0.85, 95% CI: 0.84, 0.86]. Comparing these time periods, the risk of cardiovascular deaths fell by 25% (HRa 0.75, 95% CI: 0.74, 0.77). However the risk of malignant death rose by 9% (HRa 1.09, 95% CI: 1.03, 1.16) in patients ≥65 years. CONCLUSION This European study shows a declining RRT incidence, particularly in patients aged 45-64 years, 65-74 years and secondary to diabetic nephropathy. Encouragingly, the adjusted RRT patient survival continues to improve. The risk of cardiovascular death has decreased, though the risk of death from malignancy has increased in the older population.
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Affiliation(s)
- Maria Pippias
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Torbjørn Leivestad
- Norwegian Renal Registry, Department for Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Fergus J Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, UK
| | | | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrik Finne
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Denis Fouque
- Carmen Cens Department of Nephrology, Université de Lyon F-69622, CH Lyon Sud, France
| | - James G Heaf
- Department of Medicine, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Johan De Meester
- Department of Nephrology & Dialysis & Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Marlies Noordzij
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Runolfur Palsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Oscar Zurriaga
- Valencia Region Renal Registry, Direccion General de Salud Pública, Conselleria de Sanitat, Valencia, Spain CIBERESP (Biomedical Research Consortium on Epidemiology and Public Health), Madrid, Spain
| | | | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
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Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry. Pediatr Nephrol 2014; 29:2403-10. [PMID: 25039018 DOI: 10.1007/s00467-014-2884-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The ESPN/ERA-EDTA Registry collects data on European children with end-stage renal disease receiving renal replacement therapy (RRT) who are listed on national and regional renal registries in Europe. In this paper we report on the analysis of demographic data collected from 2009 to 2011. METHODS Data on primary renal disease, incidence, prevalence, 4-year survival, transplantation rate and causes of death in paediatric patients receiving RRT were extracted from the ESPN/ERA-EDTA Registry for 37 European countries. RESULTS The incidence of RRT in paediatric patients in Europe during the study period was 5.5 cases per million age-related population (pmarp) in patients aged 0-14 years and varied markedly between countries (interquartile range 3.4-7.0 years). The prevalence of RRT was 27.9 pmarp and increased with age, with 67 % of prevalent patients living with a functioning graft. The probability of receiving a transplant within 4 years was 76.9 % and was lowest in patients aged 0-4 years (68.9 %). Mortality in paediatric patients treated with RRT was 55-fold higher than that of the general EU paediatric population. Overall survival at 4 years was 93.7 %, with the poorest survival in patients aged 0-4 years and in patients starting on dialysis. Infections (19.9 %) were the primary cause of death in European paediatric RRT patients. CONCLUSION Considerable variation exists in the current demographics of children treated with RRT across Europe.
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Tjaden LA, Vogelzang J, Jager KJ, van Stralen KJ, Maurice-Stam H, Grootenhuis MA, Groothoff JW. Long-term quality of life and social outcome of childhood end-stage renal disease. J Pediatr 2014; 165:336-342.e1. [PMID: 24837864 DOI: 10.1016/j.jpeds.2014.04.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/11/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess quality of life (QoL) and social status after 30 years of renal-replacement therapy (RRT) and to explore determinants of this QoL. STUDY DESIGN The cohort comprised all Dutch patients, born before 1979, who started RRT at age<15 years in 1972-1992. All patients still alive in 2010 were asked to complete questionnaires on QoL (RAND-36) and sociodemographic outcomes. Scores were compared with those in the age-matched general population and with previous patient scores obtained in 2000. We performed logistic regression analysis for prediction of QoL outcomes. RESULTS A total of 89 of 152 patients still alive in 2010 participated. Compared with the general population, QoL more often was impaired in patients receiving dialysis for most physical domains, in transplanted patients only on general health perception. Both transplanted and dialysis patients had normal or high scores on mental health. Scores in most physical domains were lower than in 2000. Patients were employed less often (61.8% vs 81.0%), had fewer offspring (31.5 vs 64.8%), and were less likely to have an income equal to or above average (34.8% vs 55.7%) compared with the general population. Disabilities, comorbidity, and unemployment were associated with impaired QoL. CONCLUSIONS After 30 years of RRT, adult survivors of pediatric end-stage renal disease have an impaired physical but a good mental QoL. The decrease of general health perception and physical functioning over time is worrying and may further hamper employment status and social functioning of these relatively young patients.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | - Judith Vogelzang
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Treatment Strategies to Prevent Renal Damage in Hypertensive Children. Curr Hypertens Rep 2014; 16:423. [PMID: 24522942 PMCID: PMC3960483 DOI: 10.1007/s11906-014-0423-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypertension secondary to chronic kidney disease prevails in earlier childhood and obesity-related primary hypertension in adolescence. Both are associated with a high risk of renal and cardiovascular morbidity. In children with chronic kidney disease, uncontrolled hypertension may accelerate progression to end-stage renal disease before adulthood is reached and increase a child’s risk of cardiac death a thousand-fold. Obesity-related hypertension is a slow and silent killer, and though early markers of renal damage are recognized during childhood, end-stage renal disease is a risk in later life. Renal damage will be a formidable multiplier of cardiovascular risk for adults in whom obesity and hypertension tracks from childhood. Management options to prevent renal damage will vary for these different target groups. This review provides a summary of the available renoprotective strategies in order to aid physicians involved in the care of this challenging group of children.
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