Tomoyuki Sakai1, Yoshitaka Murakami2, Yusuke Okuda3, Riku Hamada4, Yuko Hamasaki5, Kenji Ishikura6, Hiroshi Hataya4, Masataka Honda4. 1. Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan. sakai-tomoyuki@umin.ac.jp. 2. Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan. 3. Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan. 4. Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 5. Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan. 6. Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Abstract
BACKGROUND: Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous. METHODS: Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality. RESULTS: Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32). CONCLUSIONS: Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.
BACKGROUND: Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous. METHODS:Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality. RESULTS: Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32). CONCLUSIONS:Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.
Authors: Richard A Ehrenkranz; Michele C Walsh; Betty R Vohr; Alan H Jobe; Linda L Wright; Avroy A Fanaroff; Lisa A Wrage; Kenneth Poole Journal: Pediatrics Date: 2005-12 Impact factor: 7.124