Kidney Week

Abstract: TH-PO1217

Initial Treatment Modality by Etiology Among Children with ESKD

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Cen, Yong Jian, Cohen Children's Medical Center, New York, New York, United States

Yong Jian Cen, DO

• Basalely, Abby Miriam, Cohen Children's Medical Center, New York, New York, United States

Abby Miriam Basalely, MD, MS

• Castellanos, Laura J., Cohen Children's Medical Center, New York, New York, United States

Laura J. Castellanos, MD

• Shen, Carol L., Cohen Children's Medical Center, New York, New York, United States

Carol L. Shen, MD

• Frank, Rachel, Cohen Children's Medical Center, New York, New York, United States

Rachel Frank, CNN, RN

• Sethna, Christine B., Cohen Children's Medical Center, New York, New York, United States

Christine B. Sethna, MD, MEd

Background

Preemptive kidney transplantation is the recommended first treatment modality for pediatric ESKD per KDIGO 2024 guidelines. However, the distribution and determinants of initial ESKD treatment modality have not been compared across primary etiologies in children.

Methods

Using the United States Renal Data System (USRDS), children (<19 years) initiating ESKD treatment from 2012-2023 with an etiology classified as primary glomerulonephritis (GN), secondary GN/vasculitis, CAKUT, cystic/hereditary disease, interstitial nephritis, or other etiologies were identified. Logistic regression estimated the odds for preemptive transplantation vs. dialysis, adjusting for age, sex, race/ethnicity, and rurality.

Results

Among 11,229 chilldren, 58% were male, 53% were aged 12-18 years and 29% had CAKUT. Overall, 8910 (79%) received dialysis as initial treatment (57% hemodialysis, 2% continuous ambulatory peritoneal dialysis [PD], 41% continuous cyclic ambulatory PD) and 2423 (25%) received preemptive transplantation (44% living donor, 56% deceased donor). In adjusted models, CAKUT had the highest odds of preemptive transplantation (OR 5.56, 95% CI 4.68–6.60), followed by cystic/hereditary disease (OR 5.33, 95% CI 4.24–6.70), interstitial nephritis (OR 3.66, 95% CI 2.64–5.07), and other etiologies (OR 2.58, 95% CI 2.15–3.11) (reference: primary GN). In contrast, secondary GN/vasculitis had lower odds of preemptive transplantation compared to primary GN [OR 0.58, 95% CI 0.40–0.83].

Conclusion

Significant differences in initial treatment modality exist across primary ESKD etiologies in children. Given the impact of initial treatment modality on morbidity, mortality, and quality of life, identifying the drivers of these observed differences is essential to optimizing resource allocation and reducing barriers to equitable access to preemptive transplantation.

Funding

• NIDDK Support