Background Although renal-replacement therapy for children withend-stage renal disease has been used for several decades, dataon patients' long-term survival are sparse.
Methods We examined the long-term survival of all children andadolescents who were under 20 years of age when renal-replacementtherapy commenced (study period, April 1963 through March 2002),using data from the Australia and New Zealand Dialysis and TransplantRegistry. Survival was analyzed with the use of Kaplan–Meiermethods and age-standardized mortality rates. Risk factors fordeath were analyzed with the use of Cox regression analysiswith time-dependent covariates.
Results A total of 1634 children and adolescents were followedfor a median of 9.7 years. The long-term survival rate amongchildren requiring renal-replacement therapy was 79 percentat 10 years and 66 percent at 20 years. Mortality rates were30 times as high as for children without end-stage renal disease.Risk factors for death were a young age at the time renal-replacementtherapy was initiated (especially for children under 1 yearof age, among whom the risk was four times as high as for children15 to 19 years of age) and treatment with dialysis (which wasassociated with a risk more than four times as high as for renaltransplantation). Overall, a trend toward improved survivalwas observed over the four decades of the study.
Conclusions Despite improvement in long-term survival, mortalityrates among children requiring renal-replacement therapy remainsubstantially higher than those among children without end-stagerenal disease. Increasing the proportion of children treatedwith renal transplantation rather than with dialysis can improvesurvival further.
Source Information
From the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Queen Elizabeth Hospital, Adelaide, Australia (S.P.M.); and the Centre for Kidney Research and the National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead, and the School of Public Health, University of Sydney — all in Sydney (J.C.C.).
Address reprint requests to Dr. McDonald at the ANZDATA Registry, Queen Elizabeth Hospital, 28 Woodville Rd., Woodville South SA 5011, Australia, or at stephenm{at}anzdata.org.au.
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