ESPN 54th Annual Meeting

ESPN 2022


 
Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: An ESPN/ERA-EDTA Registry study
RAPHAEL SCHILD 1 SIMEON DUPONT 1 JéRôME HARAMBAT 2 ENRICO VIDAL 3 AYŞE BALAT 4 CSABA BERECZKI 5 BEATA BIENIAś 6 PER BRANDSTRÖM 7 FRANCOISE BOUX 8 SILVIA CONSOLO 9 IVANA GOJKOVIC 10 JAAP W. GROOTHOFF 11 KRISTINE HOMMEL 12 HOLGER HUBMANN 13 FIONA E. M. BRADDON 14 Tatiana E. Pankratenko 15 Fotios Papachristou 16 Lucy A. Plumb 17 Ludmila Podracka 18 Sylwester Prokurat 19 Anna Bjerre 20 Carolina Cordinhã 21 Juuso Tainio 22 Enkelejda Shkurti 23 Giuseppina Sparta 24 Karel Vondrak 25 Kitty J. Jager 26 Marjolein Bonthuis 26

1- UNIVERSITY CHILDRENS HOSPITAL, UNIVERSITY MEDICAL CENTER HAMBURG
2- DEPARTMENT OF PEDIATRICS, BORDEAUX UNIVERSITY HOSPITAL
3- DIVISION OF PEDIATRICS, DEPARTMENT OF MEDICINE, UNIVERSITY OF UDINE
4- DEPARTMENT OF PEDIATRIC NEPHROLOGY, GAZIANTEP UNIVERSITY MEDICAL FACULTY
5- DEPARTMENT OF PEDIATRICS, UNIVERSITY OF SZEGED
6- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, MEDICAL UNIVERSITY OF LUBLIN
7- THE QUEEN SILVIA CHILDREN’S HOSPITAL, THE SAHLGRENSKA ACADEMY AT THE UNIVERSITY OF GOTHENBURG
8- DEPARTMENT OF PEDIATRICS, ROUEN UNIVERSITY HOSPITAL
9- DIALYSIS AND TRANSPLANT UNIT, FONDAZIONE IRCSS CA’ GRANDE OSPEDALE MAGGIORE POLICLINICO
10- UNIVERSITY CHILDREN’S HOSPITAL, UNIVERSITY OF BELGRADE
11- EMMA CHILDREN’S HOSPITAL, AMSTERDAM UNIVERSITY MEDICAL CENTER
12- DEPARTMENT OF MEDICINE, HOLBæK HOSPITAL
13- DEPARTMENT OF PEDIATRICS, MEDICAL UNIVERSITY GRAZ
14- UK RENAL REGISTRY, BRISTOL
15- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, Moscow
16- 1st Department of Pediatrics, 37782 Aristotle University of Thessaloniki
17- Population Health Sciences, University of Bristol Medical School
18- National Institute of Children’s Health, Comenius University, Bratislava
19- Department of Nephrology & Kidney Transplantation, The Children’s Memorial Health Institute, Warsaw
20- Department of Specialised Medicine and Transplantation, Oslo University Hospital
21- Hospital Pediátrico - Centro Hospitalar Universitário de Coimbra
22- New Children’s Hospital, University of Helsinki
23- Univeristy of Medicine of Tirana, Public Health, Tirana
24- Pediatric Nephrology Unit, University Children’s Hospital Zurich
25- Department of Pediatric Nephrology, University Hospital Motol, Prague
26- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute
 
Introduction:

 

Data on extra-renal comorbidities in children on kidney replacement therapy (KRT) is scarce. Considering its high relevance for prognosis and clinical decision-making, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT.

Material and methods:

 

We included data from 4127 patients aged <20 years when commencing KRT from 2007 to 2017 from 22 European countries included in the ESPN/ERA-EDTA Registry. Comorbidities were registered at the start of KRT. Differences in access to kidney transplantation (KT), patient and graft survival were estimated using Cox proportional hazard regression.

Results:

 

At least one comorbidity was present in one third (33%) of children commencing KRT, and acquired cardiovascular diseases occurred most frequently. The comorbidity prevalence has steadily increased by 5% per year since 2007. Comorbidities were most frequent in patients from high-income countries (43% vs. 24% in low-income and 32.9 in middle-income countries). Patients with comorbidities had a lower access to transplantation (aHR 0.67, 95% CI: 0.61 - 0.74), and a higher risk of death (aHR 1.79; 95% CI: 1.38–2.32). The increased risk of death was only seen in dialysis patients (aHR 1.60; 95% CI: 1.21-2.13), and not after kidney transplantation. For both outcomes, the impact of comorbidities was stronger in low-income countries. However, once transplanted, 5-year graft survival was not affected by the presence of comorbidities (aHR for graft failure: 1.18, 95% CI: 0.84-1.65).

Conclusions:

 

Extra-renal diseases have become more frequent in children and adolescents on KRT and reduce their access to kidney transplantation as well as survival, especially when remaining on dialysis. Kidney transplantation should be considered as treatment of choice in all pediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.