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Abstract: SA-PO370

Clinical Outcomes in Children on Maintenance Dialysis: A Report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Daga, Ankana, Boston Children's Hospital, Boston, Massachusetts, United States
  • Altemose, Kathleen, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Boynton, Sara Ashley, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Neu, Alicia, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States
Background

The NAPRTCS dialysis registry includes data on 8923 children receiving chronic dialysis.

Methods

Children on maintenance dialysis at any NAPRTCS center are eligible for registry enrollment. Data is collected at dialysis initiation and at 6-month intervals until dialysis termination. Clinical characteristics and outcomes compared across eras: 1992-2000, 2001-2010, 2011-2020.

Results

Hemodialysis (HD) as the initiating dialysis modality increased (34% in 1992-2000 versus 54% in 2011-2020), while peritoneal dialysis (PD) decreased (66% to 40%). HD catheters are placed in the jugular vein more often (87% in 2010-2020 vs 51% in 1992-2020). Use of double cuffed swan neck PD catheters placed with a downward oriented exit site increased over time (5% to 25%). Mean eGFR at dialysis initiation increased from 9.2 (1992-2000), to 11.2 (2011-2020) ml/min/1.73M2. Obesity has increased over time (17% affected 2010-2020). Hypertension was common regardless of the era (35% in 2010-2020 vs 39% for entire cohort). Height remains suboptimal, with average height Z scores of -1.34 within a month of dialysis initiation falling to -1.62 at 24 months, with growth hormone use in 30% of PD and 16% of HD children. Survival at 36 months of dialysis was > 90% with children initiating dialysis > 6 years old vs 77% initiating < 1 year old. A Cox proportional hazards model adjusted for age at initiation showed survival improved with initiation after 2000 (p<0.01). Infection accounted for 22% of deaths on dialysis in 1992-2000 but only 15% in 2011-2020, whereas cardiopulmonary causes of death stayed steady at 22%. Death from infection was higher in PD vs HD (23% vs 12%, p <0.01), though annualized rates for peritonitis fell from 0.93 (95%CI: 0.89-0.98) between PD initiations in 1992-1996 to 0.28 (0.21-0.35) between 2017-2022. Cumulative incidence of transplant from the deceased donor waiting list increased, from 0.80 (95% CI: 0.75-0.84) in 1992-2000 to 0.91 (0.81-0.96) in 2011-2020.

Conclusion

Although survival on chronic dialysis has improved significantly over 30 years, hypertension, obesity, and growth delay in dialyzed children remain common morbidities. Infection rates and related mortality has decreased, but cardiopulmonary mortality has not, highlighting areas that can be improved upon in the future.