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Abstract: PO2288

Renal Replacement Therapy and Mortality Rates for Children with Posterior Urethral Valves and Prune Belly Syndrome

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Stonebrook, Emily Jacqueline, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Sebastião, Yuri Vanda, Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
  • Becknell, Brian, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Ching, Christina B., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Mcleod, Daryl J., Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Posterior Urethral Valves (PUV) and Prune Belly Syndrome (PBS) cause congenital obstructive uropathy and dysplasia in infants. Resulting chronic kidney disease and pulmonary hypoplasia may lead to renal replacement therapy (RRT), mechanical ventilation and death.

Methods

This retrospective cohort study queried The Pediatric Health Information System (PHIS) database to identify patients with PUV or PBS who were born at or admitted to a PHIS hospital by 3 months of age between 1/1/2006 and 9/20/2016. Ethnicity, race and insurance were investigated as predictor variables for time to RRT or in-hospital mortality. Prematurity and mechanical ventilation were evaluated as predictors of in-hospital mortality.

Results

1673 PUV and 236 PBS patients met inclusion criteria. There was no difference in time to RRT or mortality based on ethnicity, race, or insurance. 212 patients (11.1%) required RRT by 2 years of age. There was no difference in RRT requirement between the PUV and PBS groups.

130 patients (6.8%) died during the initial admission: 98 PUV patients (5.9%) and 32 PBS patients (13.6%), with a median time to death of 6.5 days and 2.5 days, respectively. PBS patients had an increased risk of death (Adjusted Relative Risk (ARR) 2.12, p <.00001). The difference in median time to death was not significant.

Of 381 (20%) premature patients, 79 (20.7%) died prior to discharge. 696 patients (36.5%) required mechanical ventilation, and of these, 118 (17%) died. Prematurity and mechanical ventilation were associated with an increased risk of death (ARR 2.3, p <.0001 and ARR 9.9, p<.0001 respectively).

Conclusion

The severity of the sequelae associated with PUV and PBS is affirmed by the 11.1% risk of early RRT and 6.8% in-hospital mortality. PBS patients did have an increased mortality rate compared to PUV patients. Prematurity or the requirement of mechanical ventilation was associated with an increased mortality rate. Future large, prospective studies will enable investigation of early morbidity and mortality associated with PUV and PBS, as well as long-term outcomes.