Marjolein Bonthuis1, Jérôme Harambat2, Etienne Bérard3, Karlien Cransberg4, Ali Duzova5, Liliana Garneata6, Maria Herthelius7, Adrian C Lungu8, Timo Jahnukainen9, Lukas Kaltenegger10, Gema Ariceta11, Elisabeth Maurer12, Runolfur Palsson13, Manish D Sinha14, Sara Testa15, Jaap W Groothoff16, Kitty J Jager17. 1. European Society for Pediatric Nephrology/ European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; m.bonthuis@amc.uva.nl. 2. Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France. 3. Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Nice-Hôpital Archet2, Nice, France. 4. Department of Pediatric Nephrology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. 5. Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey. 6. Department of Internal Medicine and Nephrology, Carol Davila University of Medicine and Pharmacy, Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania. 7. Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. 8. Department of Pediatric Nephrology, Fundeni Clinical Institute, Bucharest, Romania and Carol Davila University of Medicine, Pediatrics, Bucharest, Romania. 9. Department of Pediatric Nephrology and Transplantation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 10. Division of Pediatric Nephrology and Gastroenterology, Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. 11. Pediatric Nephrology Department, Hospital Universitari Vall d'Hébron, Universitat Autónoma de Barcelona, Barcelona, Spain. 12. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 13. Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 14. Department of Pediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 15. Pediatric Nephrology and Dialysis Unit, Fondazione Instituto di Ricovero e cura a Carattere Scientifico, Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; and. 16. Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. 17. European Society for Pediatric Nephrology/ European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: Data on recovery of kidney function in pediatric patients with presumed ESKD are scarce. We examined the occurrence of recovery of kidney function and its determinants in a large cohort of pediatric patients on maintenance dialysis in Europe. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data for 6574 patients from 36 European countries commencing dialysis at an age below 15 years, between 1990 and 2014 were extracted from the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Recovery of kidney function was defined as discontinuation of dialysis for at least 30 days. Time to recovery was studied using a cumulative incidence competing risk approach and adjusted Cox proportional hazard models. RESULTS: Two years after dialysis initiation, 130 patients (2%) experienced recovery of their kidney function after a median of 5.0 (interquartile range, 2.0-9.6) months on dialysis. Compared with patients with congenital anomalies of the kidney and urinary tract, recovery more often occurred in patients with vasculitis (11% at 2 years; adjusted hazard ratio [HR], 20.4; 95% confidence interval [95% CI], 9.7 to 42.8), ischemic kidney failure (12%; adjusted HR, 11.4; 95% CI, 5.6 to 23.1), and hemolytic uremic syndrome (13%; adjusted HR, 15.6; 95% CI, 8.9 to 27.3). Younger age and initiation on hemodialysis instead of peritoneal dialysis were also associated with recovery. For 42 patients (32%), recovery was transient as they returned to kidney replacement therapy after a median recovery period of 19.7 (interquartile range, 9.0-41.3) months. CONCLUSIONS: We demonstrate a recovery rate of 2% within 2 years after dialysis initiation in a large cohort of pediatric patients on maintenance dialysis. There is a clinically important chance of recovery in patients on dialysis with vasculitis, ischemic kidney failure, and hemolytic uremic syndrome, which should be considered when planning kidney transplantation in these children.
BACKGROUND AND OBJECTIVES: Data on recovery of kidney function in pediatric patients with presumed ESKD are scarce. We examined the occurrence of recovery of kidney function and its determinants in a large cohort of pediatric patients on maintenance dialysis in Europe. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data for 6574 patients from 36 European countries commencing dialysis at an age below 15 years, between 1990 and 2014 were extracted from the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Recovery of kidney function was defined as discontinuation of dialysis for at least 30 days. Time to recovery was studied using a cumulative incidence competing risk approach and adjusted Cox proportional hazard models. RESULTS: Two years after dialysis initiation, 130 patients (2%) experienced recovery of their kidney function after a median of 5.0 (interquartile range, 2.0-9.6) months on dialysis. Compared with patients with congenital anomalies of the kidney and urinary tract, recovery more often occurred in patients with vasculitis (11% at 2 years; adjusted hazard ratio [HR], 20.4; 95% confidence interval [95% CI], 9.7 to 42.8), ischemic kidney failure (12%; adjusted HR, 11.4; 95% CI, 5.6 to 23.1), and hemolytic uremic syndrome (13%; adjusted HR, 15.6; 95% CI, 8.9 to 27.3). Younger age and initiation on hemodialysis instead of peritoneal dialysis were also associated with recovery. For 42 patients (32%), recovery was transient as they returned to kidney replacement therapy after a median recovery period of 19.7 (interquartile range, 9.0-41.3) months. CONCLUSIONS: We demonstrate a recovery rate of 2% within 2 years after dialysis initiation in a large cohort of pediatric patients on maintenance dialysis. There is a clinically important chance of recovery in patients on dialysis with vasculitis, ischemic kidney failure, and hemolytic uremic syndrome, which should be considered when planning kidney transplantation in these children.
Authors: D L Gillen; C O Stehman-Breen; J M Smith; R A McDonald; B A Warady; J R Brandt; C S Wong Journal: Am J Transplant Date: 2008-09-18 Impact factor: 8.086
Authors: Ann-Maree S Craven; Carmel M Hawley; Stephen P McDonald; Johan B Rosman; Fiona G Brown; David W Johnson Journal: Perit Dial Int Date: 2007 Mar-Apr Impact factor: 1.756