Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry

Abstract

Background For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. Methods We included all children aged <15 years starting KRT 2007–2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. Results Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007–2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007–2009 or 2010–2012 (adjusted HR: 0.98, 95% CI:0.71–1.35). Conclusions We found a stable incidence and increasing prevalence of European children on KRT 2007–2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.

Demographics and long‐term outcomes of children with end‐stage kidney disease: A 20‐year territory‐wide study

“…Highest mortalities were similarly observed among young infants and dialysis populations 29 . Although historical data demonstrated improving patient outcomes, 30 survival rates have become stable in recent years 28 . We observed a similarly steady mortality across different treatment eras.…”

“…Regarding the survival of children with ESKD in Hong Kong, the overall 1‐, 5‐, 10‐, and 15‐year survivals were 100%, 94.8%, 89.7% and 87.1%, respectively, which were similar or slightly better than that reported in other developed countries 28,29 . Highest mortalities were similarly observed among young infants and dialysis populations 29 .…”

Advanced chronic kidney disease among UK children

“…The overall high prevalence of severely reduced kidney function seen in this study is predominantly due to the high proportion of children on longterm KRT, which at 65.3pmarp is higher than most European estimates. 6 The observation that higher proportions of children with advanced CKD lived in more deprived areas is concerning and warrants further investigation to determine whether this finding influences their kidney disease course and/or outcomes.…”

Cognitive and academic outcomes in children with chronic kidney disease

“…Chronic kidney disease (CKD) has a major impact on children and their families throughout their life course. Whilst mortality has improved for children with CKD primarily due to successful kidney transplantation [1][2][3][4][5], it is unclear if this has translated into improved long term neurocognitive outcomes for children with CKD. Although there have been recent improvements in the level of adult educational attainment in children with CKD [6], employment levels remain lower compared to peers and also to those with adult onset kidney disease [6,7].…”