A multicenter experience on patient and technique survival in children on chronic dialysis

• Published in: Pediatric nephrology (Berlin, West) West), 2004-01, Vol.19 (1), p.82-90
• Main Authors: Verrina, Enrico, Edefonti, Alberto, Gianoglio, Bruno, Rinaldi, Stefano, Sorino, Palma, Zacchello, Graziella, Lavoratti, Giancarlo, Maringhini, Silvio, Pecoraro, Carmine, Calevo, Maria Grazia, Turrini Dertenois, Laura, Perfumo, Francesco
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Continuous ambulatory peritoneal dialysis; Female; Hemodialysis; Humans; Infant; Infant, Newborn; Italy; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Logistic Models; Male; Patient outcomes; Peritoneal dialysis; Peritoneal Dialysis - mortality; Renal Dialysis - mortality; Retrospective Studies; Survival Analysis
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-003-1270-6

In this study we compared patient and technique survival of 163 new hemodialysis (HD) patients (age 11.4+/-3.1 years) and 295 peritoneal dialysis patients (7.7+/-4.8 years. P< 0.001), treated in 23 dialysis centers participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) during the years 1989-2000. Three HD (1.8%) and 17 CPD (5.8%) patients died; the overall average death rate was 9.8/1,000 patient-years in HD and 29.8/1,000 patient-years in CPD patients. No statistically significant difference in patient survival between CPD and HD was found, while the survival of 102 CPD children younger than 5 years at the start of dialysis was lower ( P=0.0001) than that of 193 CPD and 160 HD patients aged 5-15 years. We registered 12 modality failures among HD (7.4%) patients and 44 among CPD (14.9%) patients. The main causes were vascular access failure and patient choice in HD, and infection in CPD patients. Technique survival was lower ( P=0.007) in CPD than in HD patients; a statistically significant difference ( P=0.01) was also observed between both the 0- to 5- and the 5- to 15-year-old CPD patients and the HD patients aged 5-15 years. Logistic regression analysis confirmed age at initiation of dialysis to be a predictor of patient death ( P=0.0001) in the whole patient population, and of technique failure in HD ( P=0.006) but not in CPD patients ( P=0.16).