Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric Peritoneal Dialysis Network Registry

Abstract

Rationale & objective: Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors.

Study design: Prospective cohort study.

Setting & participants: Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017.

Exposure: Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 income groups based on gross national income) factors also were studied.

Outcome: All-cause MPD mortality.

Analytical approach: Patients were observed for 3 years, and the mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates.

Results: A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After 3 years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%).

Limitations: The interpretation of interregional survival differences as found in this study may be hampered by selection bias.

Conclusions: This study shows that the overall 3-year patient survival on pediatric MPD is high, and that country income is associated with patient survival.

Keywords: Child; death; economic disparity; end-stage renal disease (ESRD); gross national income (GNI); international differences; kidney failure; kidney replacement therapy (KRT); macroeconomics; mortality; patient survival; pediatric; peritoneal dialysis (PD); registry study; risk factors.