Yihui Zhai1, Xiaorong Liu2, Qing Yang3, Xiqiang Dang4, Shuzhen Sun5, Xiaoshan Shao6, Xuemei Liu7, Yubin Wu8, Haitao Bai9, Jianhua Mao10, Yang Dong11, Qingshan Ma12, Guogui Kang13, Wenyan Huang14, Hongtao Zhu15, Rui Fu16, Aihua Zhang17, Ruiying Xu18, Qing Sun19, Xiaoyun Jiang20, Liwen Lai21, Jianping Huang22, Jiangwei Luan23, Zhengkun Xia24, Jianjun Cui25, Mengzhun Zhao26, Xiaolin Wu27, Qiuye Zhang28, Yufeng Li29, Cuihua Liu30, Mo Wang31, Feiyan Wang32, Yuhong Tao33, Zhimin Huang34, Dongfeng Zhang35, Bo Zhao36, Chaoying Chen37, Chunlin Huang38, Xia Gao39, Qian Shen40, Ying Shen41, Hong Xu42. 1. Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China. 2. Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China. 3. Division of Nephrology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China. 4. Division of Pediatric Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China. 5. Division of Pediatric Nephrology, Shandong Provincial Hospital, Jinan, China. 6. Division of Nephrology, Guiyang Children's Hospital, Guiyang, China. 7. Division of Nephrology, Qilu Children's Hospital of Shandong University, Jinan, China. 8. Division of Pediatric Nephrology, Shengjing Hospital of China Medical University, Shenyang, China. 9. Division of Pediatric Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China. 10. Division of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. 11. Division of Nephrology, Anhui Provincial Children's Hospital, Hefei, China. 12. Division of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, China. 13. Division of Pediatric Nephrology, Ningbo Women and Children's Hospital, Ningbo, China. 14. Division of Nephrology, Shanghai Children's Hospital, Shanghai, China. 15. Division of Pediatric Nephrology, The First Hospital of Xinjiang Medical University, Urumqi, China. 16. Division of Nephrology, Jiangxi Children's Hospital, Nanchang, China. 17. Division of Nephrology, Nanjing Children's Hospital, Nanjing, China. 18. Division of Pediatric Nephrology, Qilu Hospital of Shandong University, Jinan, China. 19. Division of Pediatric Nephrology, Qingdao Women and Children's Hospital, Qingdao, China. 20. Division of Pediatric Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 21. Division of Pediatric Nephrology, The third People's Hospital of Jingdezhen, Nanchang, China. 22. Division of Nephrology, Bayi Children's Hospital, The Military General Hospital of Beijing PLA, Beijing, China. 23. Division of Pediatric Nephrology, Wuhan Women and Children's Hospital, Wuhan, China. 24. Division of Pediatric Nephrology, National Clinical Research Center of Kidney Disease, Jinlin Hospital, Nanjing, China. 25. Division of Nephrology, Shanxi Children's Hospital, Taiyuan, China. 26. Division of Pediatric Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. 27. Division of Pediatric Nephrology, Hubei Women and Children's Hospital, Wuhan, China. 28. Division of Pediatric Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China. 29. Division of Pediatric Nephrology, Xin Hua Hospital Affiliated, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 30. Division of Nephrology, Henan Children's Hospital, Henan, China. 31. Division of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China. 32. Division of Nephrology, Urumqi Children's Hospital, Urumqi, China. 33. Division of Pediatric Nephrology, West China Second University Hospital, Chengdu, China. 34. Division of Pediatric Nephrology, The Affiliated Hospital of Guangdong University, Guangzhou, China. 35. Division of Nephrology, Children's Hospital of Hebei Province, Shijiazhuang, China. 36. Division of Nephrology, Kunming Children's Hospital, Kunming, China. 37. Division of Nephrology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China. 38. Division of Nephrology, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. 39. Division of Pediatric Nephrology, Gansu Provincial Hospital, Lanzhou, China. 40. Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China. shenqian@shmu.edu.cn. 41. Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China. shenying@bch.com.cn. 42. Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China. hxu@shmu.edu.cn.
Abstract
BACKGROUND: In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. METHODS: Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. RESULTS: Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). CONCLUSIONS: The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.
BACKGROUND: In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. METHODS: Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. RESULTS: Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). CONCLUSIONS: The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.