Long-term follow-up data are few in children with ESRD. We sought to describe long-term survival, assess risk factors for death, and compare survival between two time periods in pediatric ESRD patients.
We used a population-based retrospective cohort utilizing data from a national organ failure registry and from Canada's universal healthcare system. We included 843 children (ages, 0 to 18) initiating renal replacement therapy from 1992 to 2007 and followed them until death or date of last contact (median follow-up, 6.8 years; interquartile range, 3.0 to 10.6). We assessed risk factors for death and examined cause-specific mortality.
During 5991 patient-years of follow-up, 107 (12.7%) patients died. Unadjusted cumulative survival for the cohort was: 91.7% (95% CI, 89.8 to 93.7%) at 5 years and 85.8% (95% CI, 82.8 to 88.8%) at 10 years. Among patients commencing dialysis, overall adjusted survival was poorest among those who started dialysis at age 2 years on dialysis before transplant (hazard ratio, 1.53; 95% CI, 0.63 to 3.67).
No significant improvements in survival were observed among ESRD patients over the study period. Time with transplant function had the strongest association with survival. Pre-emptive transplantation was not associated with improved survival in adjusted models.
Cites: N Engl J Med. 2000 May 18;342(20):1478-8310816185