Long-term outcome of chronic dialysis in children

Abstract

As the prevalence of children on renal replacement therapy (RRT) increases world wide and such therapy comprises at least 2% of any national dialysis or transplant programme, it is essential that paediatric nephrologists are able to advise families on the possible outcome for their child on dialysis. Most children start dialysis with the expectation that successful renal transplantation is an achievable goal and will provide the best survival and quality of life. However, some will require long-term dialysis or may return intermittently to dialysis during the course of their chronic kidney disease (CKD). This article reviews the available outcome data for children on chronic dialysis as well as extrapolating data from the larger adult dialysis experience to inform our paediatric practice. The multiple factors that may influence outcome, and, particularly, those that can potentially be modified, are discussed.

Fig. 1

Kaplan–Meier graphs of overall rates of survival (stratified by age groups and decade during which renal replacement therapy began) among children and adolescents in Australia and New Zealand from 1965 to 2005. All patients were followed until death or the end of follow-up at 31 December 2005. The number of patients at risk at each time point is shown below each graph. We are grateful to Drs. Stephen McDonald and Jonathan Craig for providing this figure from the ANZDATA Registry

Fig. 2

Cardiovascular changes, underlying risk factors, investigations for assessment and the clinical outcomes in patients with CKD, ECHO Echocardiogram, FMD Flow mediated dilatation, IMT Intima media thickness, PWV Pulse wave velocity, EBCT Electron Beam Computed Tomography, MS-CT Multi-Slice Computed Tomography