Twenty-five Years of Infant Dialysis: A Single Center Experience

Outcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life

“…5,8,20,22 The substantial mortality risk associated with the diagnosis of autosomal recessive polycystic kidney disease is well characterized and reflects the previous findings of Guay-Woodford and Desmond, and others who found an exceedingly high mortality rate in neonates with autosomal recessive polycystic kidney disease who required surgery for relief of abdominal pressure or to initiate PD. [23][24][25] Consistent with recent single-center reports 8,9 and the report by van Stralen et al 5 based on patient experiences between 2000 and 2011, most of the mortality seen in the past cohort of neonates and infants occurred during the first year after dialysis initiation. In contrast, the course of overall mortality for the more recently treated neonates and infants in the NAPRTCS dialysis database appears to be more gradual over the first 3 years of maintenance dialysis.…”

“…[1][2][3][4][5] Even with the early initiation of maintenance dialysis therapy, these patients are at high risk for a variety of morbidities and mortality. [6][7][8] This is especially true for those who initiate dialysis during the neonatal period. 1,4,5,8,9 Despite advances in the medical and surgical management of all infants ,1 year with ESRD, it is unclear whether the outcome of those who receive chronic dialysis therapy has improved over time.…”

“…[6][7][8] This is especially true for those who initiate dialysis during the neonatal period. 1,4,5,8,9 Despite advances in the medical and surgical management of all infants ,1 year with ESRD, it is unclear whether the outcome of those who receive chronic dialysis therapy has improved over time.…”

“…2,4,5 Single-center studies presumably reflect the outcomes of consistent management practices, but their patient volumes and/or followup periods tend to be quite limited. [6][7][8] Given the discrepancies between registry and single-center outcomes and the limitations of each type of study, there is good reason that many physicians find it difficult to counsel families with confidence about the long-term prognosis of these patients, and in turn, some physicians who care for infants with ESRD (eg, neonatologists and nephrologists) remain hesitant to offer maintenance dialysis or initiate the transplant process. [10][11][12] We therefore conducted the following study to provide some additional data on the issue of the outcome of infants who initiate chronic dialysis during the first year of life, hypothesizing that patient survival and transplantation outcomes have improved in recent years among patients registered in the NAPRTCS database.…”

“…After this transition from maintenance dialysis to renal transplantation, graft survival among the recently transplanted infants was better than that of infants in the past cohort and is consistent with the results of recent single-center reports and those published by the Scientific Registry of Transplant Recipients. [6][7][8]27 Because graft survival has consistently improved among all pediatric age groups over the past few decades as a result of a variety of factors, including improved immunosuppression and surgical technique and a better understanding of transplant-related immunology, 28 there is every reason to expect that transplant outcomes will continue to improve overall and among the youngest patients.…”