Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study.

Autor:	Preka E; Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Bonthuis M; ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands., Harambat J; Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France., Jager KJ; ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands., Groothoff JW; Amsterdam UMC, University of Amsterdam, Department of Paediatric Nephrology, Emma Children's Academic Medical Center, Amsterdam, The Netherlands., Baiko S; Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus., Bayazit AK; Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Turkey., Boehm M; Department of Pediatric Nephrology, University Children's Hospital, Vienna, Austria., Cvetkovic M; Nephrology Department, University Children's Hospital, Belgrade, Serbia., Edvardsson VO; Children's Medical Center, Landspitali-The National University Hospital of Iceland, and Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland., Fomina S; Department of Pediatric Nephrology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine., Heaf JG; Department of Medicine, Zealand University Hospital, Roskilde, Denmark., Holtta T; Children's Hospital, University of Helsinki, Helsinki, Finland., Kis E; Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary., Kolvek G; Pediatric Department, Faculty of Medicine, Safarik University, Kosice, Slovakia., Koster-Kamphuis L; Department of Pediatric Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands., Molchanova EA; Department of Kidney Transplantation, Russian Children's Clinical Hospital, Moscow, Russia., Muňoz M; Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain., Neto G; Paediatric Nephrology Unit, Hospital de Dona Estefânia, Lisbon, Portugal., Novljan G; Department of Pediatric Nephrology, University Medical Center Ljubjana, Faculty of Medicine, University of Ljubjana, Slovenia., Printza N; 1st Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece., Sahpazova E; University Pediatric Clinic, Skopje, FYR of Macedonia., Sartz L; Department of Clinical Sciences, Pediatric Nephrology, Skåne University Hospital, Lund University, Lund, Sweden., Sinha MD; Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Vidal E; Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy., Vondrak K; Department of Pediatrics, University Hospital Motol, Prague, Czech Republic., Vrillon I; Pediatric Nephrology Department, Nancy University Hospital, Nancy, France., Weber LT; Pediatric Nephrology, Childreńs and Adolescents` Hospital, University Hospital of Cologne, Cologne, Germany., Weitz M; Pediatric Nephrology, University Children's Hospital Zurich, Zurich, Switzerland., Zagozdzon I; Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland., Stefanidis CJ; Department of Pediatric Nephrology, 'Mitera' Children's Hospital, Athens, Greece., Bakkaloglu SA; Department of Pediatric Nephrology, Gazi University, Ankara, Turkey.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2019 Nov 01; Vol. 34 (11), pp. 1932-1940.
DOI:	10.1093/ndt/gfz069
Abstrakt:	Background: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment. Methods: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias. Results: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings. Conclusions: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival. (© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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