ESPN 51th Annual Meeting

ESPN 2018


 
Comorbidities in European children with end-stage renal disease: A study from the ESPN/ERA-EDTA Registry
MARJOLEIN BONTHUIS 1 JéRôME HARAMBAT 2 KITTY J. JAGER 1 JAAP W. GROOTHOFF 3

1- ESPN/ERA-EDTA REGISTRY, DEPARTMENT OF MEDICAL INFORMATICS, ACADEMIC MEDICAL CENTER, UNIVERSITY OF AMSTERDAM, AMSTERDAM PUBLIC HEALTH RESEARCH INSTITUTE, AMSTERDAM, THE NETHERLANDS
2- PEDIATRIC NEPHROLOGY UNIT, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, EMMA CHILDREN’S HOSPITAL, ACADEMIC MEDICAL CENTER, UNIVERSITY OF AMSTERDAM, AMSTERDAM, THE NETHERLANDS
 
Introduction:

Many paediatric patients with end-stage renal disease suffer from comorbidities. Data in European paediatric patients are scarce, therefore we aimed to report on the prevalence of comorbidities at the start of renal replacement therapy (RRT) and to evaluate associations between comorbidities and access to kidney transplantation and mortality.

Material and methods:

We included data from children aged <20 years when commencing RRT between 2007 and 2015 from 23 European countries included in the ESPN/ERA-EDTA Registry. We categorised countries in tertiles according to the gross domestic product per capita (GDP). Associations between comorbidities and access to transplantation or mortality were assessed with Cox proportional hazard regression.

Results:

Of the 4160 patients starting RRT, 1587 (38%) patients had at least one reported comorbidity; 17% suffered from multiple comorbidities. Cardiac abnormalities occurred most often (17%), followed by cognitive impairment (7%), systemic disease and neurological disorders (both 6%), and motor impairment (4%). Prevalence of comorbidities was higher in females, in children with cystic kidney disease or hereditary nephropathy, and in children from high income countries. Nearly 5% of all patients had at least two of the following comorbidities: cognitive impairment, motor impairment, neurological disorders, chromosomal abnormalities, or a defined syndrome and were classified as having severe comorbidities. After adjustment for age at RRT, sex, primary renal disease, and GDP, having a comorbidity was associated with a lower likelihood of transplantation (HR: 0.79, 95% CI: 0.72-0.86) and a higher mortality risk (HR: 1.83, 95% CI: 1.40-2.39).

Conclusions:

Over one third of European children had one or more comorbidities when commencing RRT and 5% had severe comorbidities. These children were less likely to receive a transplant and had a higher mortality risk than patients without any comorbidity. Further analyses will focus on country differences in the acceptance of patients with severe comorbidities on RRT.