ESPN 51th Annual Meeting

ESPN 2018


 
Ten-year trends in epidemiology and outcome of pediatric end-stage renal disease in France
CYRIELLE PARMENTIER 1 CECILE COUCHOUD 2 MARIE-ALICE MACHER 2 JEROME HARAMBAT 3 JULIEN HOGAN 4 MATHILDE LASSALLE 2

1- HOPITAL TROUSSEAU, APHP, PARIS, FRANCE
2- REIN REGISTRY, AGENCE DE LA BIOMEDECINE, FRANCE
3- CHU BORDEAUX, FRANCE
4- HOPITAL ROBERT-DEBRE, APHP, PARIS, FRANCE
 
Introduction:

We aimed to provide a ten-year overview of pediatric end-stage renal disease (ESRD) incidence, renal replacement therapy (RRT) modalities and outcome in France.

Material and methods:

Data from the REIN Registry, a French population-based database with a high quality control, was used. All children and adolescents aged less than 20 years, living in France who started RRT from 2007 to 2016 were included. We compared our data to ERA-EDTA Registry. Age and sex standardized incidence and prevalence rates expressed as per million age-related populations (pmarp) were calculated.

Results:

From 2007 to 2016, 1176 patients started RRT (58% boys, median age 14.1). The incidence of ESRD remained stable between 6 and 9 pmarp (median 7.24), a value within the overall European average. ESRD prevalence increased from 2007 to 2010, currently remains around 53 pmarp. The main causes of ESRD were CAKUT (36%) and hereditary nephropathies (35%). We observed a much higher rate of hemodialysis (HD) (59%) as first treatment modality than peritoneal dialysis (PD) (21%). PD use was relatively low compared to other European countries and tended to decline over the last 3 years of our study (31% in 2014 vs. 17% in 2016). PD was mostly used in children under 5 years old (37%).  Over the study period, 30 to 40% children started dialysis in emergency each year. About 21% of the patients were preemptively transplanted. Two years after RRT start, the cumulative incidence of transplantation varied by age: 53%, 95%CI [45.3-60.2] for 0-4 years, 79% [75.8-82.3] for 5-17 years and 61% [54.9-67.5] for young adults (aged 18-19). The 5-year patients survival is 96%, but it is lower in children under 5 years (91%).

Conclusions:

Incidence of pediatric ESRD remained stable over the last 10 years in France. Unlike other European countries, the use of PD as first RRT modality is declining. Access to transplantation for registered patients is more rapid than for young adult patients. To Increase preemptive transplantation and to decrease dialysis start in emergency remain challenges for pediatric nephrologists.