ESPN 51th Annual Meeting

ESPN 2018


 
Association between timing of dialysis initiation and clinical outcomes in the paediatric population: results from the ESPN/ERA-EDTA Registry
EVGENIA PREKA 1 MARJOLEIN BONTHUIS 2 KITTY JAGER 2 SEVCAN BAKKALOGLU 3 CONSTANTINOS J STEFANIDIS 4 JEROME HARAMBAT 5 JAAP W GROOTHOFF 6

1- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON UK
2- DEPARTMENT OF MEDICAL INFORMATICS, ESPN/ERA-EDTA REGISTRY AND ERA-EDTA REGISTRY, AMSTERDAM, THE NETHERLANDS
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, GAZI UNIVERSITY, ANKARA, TURKEY
4- DEPARTMENT OF PEDIATRIC NEPHROLOGY, "MITERA" CHILDRENS HOSPITAL, ATHENS, GREECE
5- DEPARTMENT OF PEDIATRICS, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
6- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, EMMA CHILDRENS HOSPITAL AMC, AMSTERDAM, THE NETHERLANDS
 
Introduction:

There is no consensus concerning the debatable issue of timing of initiation of dialysis in children with ESRD. Our study aimed to investigate the association between eGFR at dialysis initiation and clinical outcomes in a cohort of European children starting renal replacement therapy.

Material and methods:

We included 2963 children from 21 countries participating in the ESPN/ERA-EDTA Registry who started dialysis below 18 years of age between 2000 and 2014. Two groups were compared according to estimated eGFR at start: eGFR ≥ 8 ml/min/1.73m2 (‘early starters’) and eGFR < 8 ml/min/1.73m2 (‘late starters’). The primary outcomes studied were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead-time bias.

Results:

Median eGFR at start of dialysis was 6.1 versus 10.5 ml/min/1.73m2, respectively for late and early starters. Late starters were younger than early starters (9.4, IQR 2.6-14.1 versus 11.0 IQR 5.7-14.5 years). Overall 5-year mortality risk on dialysis (average 91.1%) and 1-, 2- and 5-year access to transplantation were all similar in early and late starters. One-year evolution of height SDS was similar among the groups, whereas anaemia and hypertension were more prevalent among late initiators, even when considering the patients having at least 3 months between first visit to a nephrologist and dialysis initiation. Hyperphosphataemia was more frequently observed after early initiation of dialysis. 

Conclusions:

In this large cohort study of paediatric patients, there was no association between timing of dialysis initiation and mortality, access to transplantation, and growth. However special attention to hypertension and anaemia should be paid in children for whom dialysis is initiated at a low eGFR.