Kidney Week

Abstract: SA-PO462

Primary Cause of Kidney Disease and Mortality in Children on Dialysis

Session Information

• Pediatric Nephrology - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yusuke Okuda,

• Soohoo, Melissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Melissa Soohoo,

• Obi, Yoshitsugu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yoshitsugu Obi,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Elani Streja,

• Tang, Ying, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Ying Tang,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Connie Rhee,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

Congenital anomalies of the kidney and urinary tract (CAKUT) has been associated with slower progression of chronic kidney disease in children. However, little is known about the association of CAKUT vs. other primary causes of kidney disease with mortality risk after dialysis initiation.

Methods

We used the United States Renal Data System to identify 25,761 incident dialysis patients who were ≤21 years old between 1995–2016. We examined the risk of the primary cause of kidney disease with mortality using adjusted Cox models. Sensitivity analyses included stratification on age and individual non-CAKUT causes, and propensity score (PS)-matched analyses. The PS was calculated based on case mix variables.

Results

The median (IQR) age was 17 (11–19) years and 4,780 (19%) had CAKUT. The case mix-adjusted hazard ratio (HR) for CAKUT patients was 0.72 (95%CI, 0.64–0.81) (ref: non-CAKUT). In age stratified analysis, the case mix-adjusted HRs (95%CIs) for CAKUT patients were 0.66 (0.54–0.80), 0.56 (0.39–0.80), 0.66 (0.50–0.86), 0.97 (0.80–1.18) in <6 years, 6–<13 years, 13–<18 years, and ≥18 years, respectively (ref: non-CAKUT) [Figure]. Among the non-CAKUT causes, mortality associated with primary glomerulonephritis (HR, 0.93; 95%CI, 0.80–1.10) and focal segmental glomerulosclerosis (HR, 0.89; 95%CI, 0.75–1.04) was comparable or slightly lower compared to CAKUT, whereas most other causes were associated with higher mortality risk. The lower mortality risk in CAKUT patients was consistent in the PS-matched cohort.

Conclusion

CAKUT was associated with lower mortality in children on dialysis, especially in those younger than 18 years old. Additional studies are needed to investigate the mortality risk for rare non-CAKUT causes.

Funding

• NIDDK Support