In a study that included more than 20,000 patients, there was a significant decrease in the United States in mortality rates over time among children and adolescents initiating end-stage kidney disease treatment with dialysis between 1990 and 2010, according to a study in the May 8 issue of JAMA. The study is being released early online to coincide with its presentation at the Pediatric Academic Societies annual meeting.
"Individuals with end-stage kidney disease (ESKD) face a significantly shortened life expectancy. In no group of ESKD patients is the loss of potential years of life larger than in children and adolescents. Although transplant remains the treatment of choice to maximize survival, growth, and development, 75 percent of children with ESKD require treatment with dialysis prior to receiving a kidney transplant. Dialysis is therefore a life-saving therapy for children with ESKD while they await transplant. Nevertheless, all-cause mortality rates in children receiving maintenance dialysis are at least 30 times higher than the general pediatric population, with even higher relative risks in very young children," the authors write. "There have been substantial improvements in the care of children with ESKD between 1990 and 2010. However, to our knowledge, it is not known if mortality has changed over time in the United States, particularly in recent years."
Mark M. Mitsnefes, M.D., M.Sc., of Cincinnati Children's Hospital Medical Center, and colleagues conducted a study to determine if all-cause, cardiovascular, and infection-related mortality rates have changed between 1990 and 2010 among patients younger than 21 years of age with ESKD initially treated with dialysis and if changes in mortality rates over time differed by age at treatment initiation. The researchers used data from the United States Renal Data System. Children with a prior kidney transplant were excluded.