BACKGROUND AND OBJECTIVES: 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. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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. RESULTS: 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 <1 year. No secular trends in survival were noted for either dialysis or transplant patients. The proportion of incident patients receiving pre-emptive transplantation increased over time. Pre-emptively transplanted patients did not demonstrate superior adjusted survival compared with those who spent >2 years on dialysis before transplant (hazard ratio, 1.53; 95% CI, 0.63 to 3.67). CONCLUSIONS: 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.
BACKGROUND AND OBJECTIVES: 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 ESRDpatients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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. RESULTS: 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 <1 year. No secular trends in survival were noted for either dialysis or transplant patients. The proportion of incident patients receiving pre-emptive transplantation increased over time. Pre-emptively transplanted patients did not demonstrate superior adjusted survival compared with those who spent >2 years on dialysis before transplant (hazard ratio, 1.53; 95% CI, 0.63 to 3.67). CONCLUSIONS: No significant improvements in survival were observed among ESRDpatients 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.
Authors: H Holdaas; B Fellström; E Cole; G Nyberg; A G Olsson; T R Pedersen; S Madsen; C Grönhagen-Riska; H-H Neumayer; B Maes; P Ambühl; A Hartmann; B Staffler; A G Jardine Journal: Am J Transplant Date: 2005-12 Impact factor: 8.086
Authors: W G Goodman; J Goldin; B D Kuizon; C Yoon; B Gales; D Sider; Y Wang; J Chung; A Emerick; L Greaser; R M Elashoff; I B Salusky Journal: N Engl J Med Date: 2000-05-18 Impact factor: 91.245
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Authors: Nigel I T Orr; Stephen P McDonald; Steven McTaggart; Paul Henning; Jonathan C Craig Journal: Pediatr Nephrol Date: 2009-04-17 Impact factor: 3.714
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Authors: Nicholas Chesnaye; Marjolein Bonthuis; Franz Schaefer; Jaap W Groothoff; Enrico Verrina; James G Heaf; Augustina Jankauskiene; Viktorija Lukosiene; Elena A Molchanova; Conceicao Mota; Amira Peco-Antić; Ilse-Maria Ratsch; Anna Bjerre; Dimitar L Roussinov; Alexander Sukalo; Rezan Topaloglu; Koen Van Hoeck; Ilona Zagozdzon; Kitty J Jager; Karlijn J Van Stralen Journal: Pediatr Nephrol Date: 2014-07-21 Impact factor: 3.714