End-stage renal disease requiring renal replacement therapy (RRT) during the neonatal period is a very rare condition, and little information is available regarding long-term RRT and outcomes. To gain more information, we performed a collaborative study on patient characteristics and treatment outcomes in children who started RRT as neonates during their first month of life between 2000 and 2011 who were prospectively registered in the ESPN/ERA-EDTA, the IPPN (since 2007), the Japanese registry, or the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry. During the first month of life, 264 patients from 32 countries started RRT and were followed for a median of 29 months (interquartile range 11-60 months). Most neonates (242) started on peritoneal dialysis, 21 started on hemodialysis, and 1 patient with a transplant. The most important causes of renal failure were congenital anomalies of the kidney and urinary tract in 141, cystic kidneys in 35, and cortical necrosis in 30. Within 2 years after the start of RRT, 69 children changed dialysis modality and 53 received a renal transplant. After a median of 7 months, 45 children had died, mainly because of infection, resulting in an estimated 2-year survival of 81%, and 5-year survival of 76%. Growth retardation (63%), anemia (55%), and hypertension (57%) were still major problems after 2 years. Thus, relatively good medium-term patient survival may be achieved with RRT started during the neonatal period, but specific therapeutic challenges continue to exist in this age group.

BackgroundHealth care transition of adolescents with chronic conditions may be unsuccessful when patients have not acquired the necessary skills and developmental milestones. It is therefore critical for health care providers to assess the readiness for transition of their adolescent patients. This is currently hindered by the lack of a recognised, well-established transition-readiness assessment tool.MethodsWe conducted a systematic review of all transition-readiness tools for adolescents with chronic medical conditions published in peer-reviewed journals. Tools were rated by the methodological quality of the validation studies, and the psychometric measurement qualities of each tool.ResultsTen different assessment tools were identified. Seven targeted specific diseases and 3 tools were generic. Most tools were poorly validated with only one tool, the Transition Readiness Assessment Questionnaire (TRAQ) demonstrating adequate content validity, construct validity, and internal consistency.ConclusionThe TRAQ was the best-validated transition-readiness tool, with additional benefits of disease-neutrality. Further research should focus on testing the predictive validity of this tool, and exploring correlation with transition-outcomes, in an international population.

Earlier, better prediction of severe AKI has the potential to improve AKI associated patient outcomes. Compared to isolated, context-free changes in SCr, renal angina risk assessment improved accuracy for prediction of severe AKI in critically ill children and young adults.

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