Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study

Autor: Raphael Schild, Simeon Dupont, Jérôme Harambat, Enrico Vidal, Ayşe Balat, Csaba Bereczki, Beata Bieniaś, Per Brandström, Francoise Broux, Silvia Consolo, Ivana Gojkovic, Jaap W Groothoff, Kristine Hommel, Holger Hubmann, Fiona E M Braddon, Tatiana E Pankratenko, Fotios Papachristou, Lucy A Plumb, Ludmila Podracka, Sylwester Prokurat, Anna Bjerre, Carolina Cordinhã, Juuso Tainio, Enkelejda Shkurti, Giuseppina Spartà, Karel Vondrak, Kitty J Jager, Jun Oh, Marjolein Bonthuis
Rok vydání: 2023
Předmět:
Zdroj: Clinical Kidney Journal. 16:745-755
ISSN: 2048-8513
2048-8505
Popis: Background Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. Methods We included data from patients Results Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61–0.74]} and a higher risk of death [aHR 1.79 (95% CI 1.38–2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21–2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84–1.65)]. Conclusions Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.
Databáze: OpenAIRE
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