Julien Hogan1,2, Bruno Ranchin3, Marc Fila4, Jérome Harambat5, Saoussen Krid6, Isabelle Vrillon7, Gwenaelle Roussey8, Michel Fischbach9, Cécile Couchoud10. 1. Pediatric Nephrology Unit, Robert Debré Hospital APHP, 48 bld Serurier, 75019, Paris, France. julien.hogan@aphp.fr. 2. REIN Registry, Agence de la biomédecine, Saint-Denis, La Plaine, France. julien.hogan@aphp.fr. 3. Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. 4. Pediatric Nephrology Unit, Arnaud de Villeneuve Hospital, Montpellier, France. 5. Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France. 6. Pediatric Nephrology Unit, Necker Hospital, Paris, France. 7. Pediatric Nephrology Unit, Hôpital d'Enfants Brabois, Nancy, France. 8. Pediatric Nephrology Unit, Nantes University Hospital, Nantes, France. 9. Pediatric Nephrology Unit, Hautepierre University Hospital, Strasbourg, France. 10. REIN Registry, Agence de la biomédecine, Saint-Denis, La Plaine, France.
Abstract
BACKGROUND: Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. METHODS: We included all patients aged <20 years at the start of renal replacement therapy (RRT), recorded in the French RRT Registry between 2002 and 2013. Hierarchical logistic regression models were used to study the association between the patient/center characteristics and the probability of receiving PD as the first dialysis modality. RESULTS: We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. CONCLUSIONS: Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.
BACKGROUND: Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. METHODS: We included all patients aged <20 years at the start of renal replacement therapy (RRT), recorded in the French RRT Registry between 2002 and 2013. Hierarchical logistic regression models were used to study the association between the patient/center characteristics and the probability of receiving PD as the first dialysis modality. RESULTS: We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. CONCLUSIONS: Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.
Authors: Jenny I Shen; Aya A Mitani; Anjali B Saxena; Benjamin A Goldstein; Wolfgang C Winkelmayer Journal: Perit Dial Int Date: 2012-10-02 Impact factor: 1.756