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.

Aliasghar Clinical Research Development Center Iran University of Medical Sciences Tehran Iran

Children's Hospital of Fudan University Shanghai People's Republic of China

Children's Mercy Kansas City MO

Department of Paediatric and Adolescent Medicine Hong Kong Children's Hospital Hong Kong People's Republic of China

Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia

Department of Pediatric Nephrology National Kidney and Transplant Institute Quezon City Philippines

Department of Pediatric Nephrology School of Medicine Gazi University Ankara Turkey

Department of Pediatrics Faculty of Medical Sciences Zabrze Medical University of Silesia Katowice Poland

Division of Pediatric Nephrology Center for Pediatrics and Adolescent Medicine Heidelberg University Heidelberg Germany

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

Fondazione Ospedale Maggiore Policlinico Milan Italy

Great Ormond Street Hospital London United Kingdom

Hospital Infantil de Nicaragua Manuel de Jesus Rivera Managua Nicaragua

IPNA Global RRT Registry Department of Medical Informatics Amsterdam UMC University of Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands

Nationwide Children's Hospital Columbus OH

NRS Medical College and Hospital Kolkata India

Pediatric Nephrology Center of Excellence Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia

Pediatrics Seoul National University Children's Hospital Seoul South Korea

Roberto del Río Hospital Santiago Chile

RTS Medellin Colombia

School of Medicine Johns Hopkins University Baltimore MD

Service de Néphrologie Pédiatrique Hôpital Jeanne De Flandre Lille France

Starship Children's Hospital Auckland New Zealand

University Hospital Motol Prague Czech Republic

References provided by Crossref.org

Real-world evidence on the dosing and safety of C.E.R.A. in pediatric dialysis patients: findings from the International Pediatric Dialysis Network registries