Erica Winnicki1,2, Kirsten L Johansen3,4, Michael D Cabana2,5, Bradley A Warady6, Charles E McCulloch5, Barbara Grimes5, Elaine Ku7,2,5,8. 1. Division of Nephrology, Erica.winnicki@ucsf.edu. 2. Departments of Pediatrics. 3. Division of Nephrology, Department of Medicine, Hennepin Healthcare Medical Center, Minneapolis, Minnesota. 4. Division of Nephrology, University of Minnesota, Minneapolis, Minnesota; and. 5. Epidemiology and Biostatistics, and. 6. Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri. 7. Division of Nephrology. 8. Department of Medicine, University of California, San Francisco, California.
Abstract
BACKGROUND: Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. METHODS: To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1-18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2). RESULTS: Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality-hemodialysis versus peritoneal dialysis (P<0.001 for interaction)-and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively). CONCLUSIONS: In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.
BACKGROUND: Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. METHODS: To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1-18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2). RESULTS: Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality-hemodialysis versus peritoneal dialysis (P<0.001 for interaction)-and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively). CONCLUSIONS: In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.
Authors: Maarten A M Jansen; Augustinus A M Hart; Johanna C Korevaar; Friedo W Dekker; Elisabeth W Boeschoten; Raymond T Krediet Journal: Kidney Int Date: 2002-09 Impact factor: 10.612
Authors: Srinivasan Beddhu; Matthew H Samore; Mark S Roberts; Gregory J Stoddard; Nirupama Ramkumar; Lisa M Pappas; Alfred K Cheung Journal: J Am Soc Nephrol Date: 2003-09 Impact factor: 10.121
Authors: Vianda S Stel; Friedo W Dekker; David Ansell; Hans Augustijn; Francesco G Casino; Frederic Collart; Patrik Finne; George A Ioannidis; Mario Salomone; Jamie P Traynor; Oscar Zurriaga; Enrico Verrina; Kitty J Jager Journal: Nephrol Dial Transplant Date: 2009-06-10 Impact factor: 5.992
Authors: Gary L Myers; W Greg Miller; Josef Coresh; James Fleming; Neil Greenberg; Tom Greene; Thomas Hostetter; Andrew S Levey; Mauro Panteghini; Michael Welch; John H Eckfeldt Journal: Clin Chem Date: 2005-12-06 Impact factor: 8.327
Authors: George J Schwartz; Alvaro Muñoz; Michael F Schneider; Robert H Mak; Frederick Kaskel; Bradley A Warady; Susan L Furth Journal: J Am Soc Nephrol Date: 2009-01-21 Impact factor: 10.121