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Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study
R. Schild, S. Dupont, J. Harambat, E. Vidal, A. Balat, C. Bereczki, B. Bieniaś, P. Brandström, F. Broux, S. Consolo, I. Gojkovic, JW. Groothoff, K. Hommel, H. Hubmann, FEM. Braddon, TE. Pankratenko, F. Papachristou, LA. Plumb, L. Podracka, S....
Status not-indexed Language English Country England, Great Britain
Document type Journal Article
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PubMed Central
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PubMed
37007701
DOI
10.1093/ckj/sfad008
Knihovny.cz E-resources
- Publication type
- Journal Article MeSH
BACKGROUND: Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. METHODS: We included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression. RESULTS: Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74]} and a higher risk of death [aHR 1.79 (95% CI 1.38-2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21-2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84-1.65)]. CONCLUSIONS: Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.
Department of Medicine Holbæk Hospital Holbæk Denmark
Department of Nephrology University Children's Hospital University of Belgrade Belgrade Serbia
Department of Paediatric Nephrology Medical University of Lublin Lublin Poland
Department of Pediatric Nephrology Gaziantep University Medical Faculty Gaziantep Turkey
Department of Pediatric Nephrology University Hospital Motol Prague Czech Republic
Department of Pediatrics Medical University Graz Graz Austria
Department of Pediatrics Rouen University Hospital Rouen France
Department of Pediatrics University of Szeged Szeged Hungary
Division of Pediatric Nephrology University Medical Center Hamburg Eppendorf Hamburg Germany
Division of Pediatrics Department of Medicine University of Udine Udine Italy
Moscow Regional Research and Clinical Institute named after M F Vladimirskiy Moscow Russia
Pediatric Department National Institute of Children's Health Comenius University Bratislava Slovakia
Pediatric Nephrology Unit University Children's Hospital Zurich Zurich Switzerland
Population Health Sciences University of Bristol Medical School Bristol UK
Univeristy of Medicine of Tirana Public Health Tirana Albania
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- $a BACKGROUND: Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. METHODS: We included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression. RESULTS: Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74]} and a higher risk of death [aHR 1.79 (95% CI 1.38-2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21-2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84-1.65)]. CONCLUSIONS: Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.
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