Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study - Bordeaux Population Health Access content directly
Journal Articles Clinical Kidney Journal Year : 2023

Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study

Raphael Schild
  • Function : Author
Simeon Dupont
  • Function : Author
Enrico Vidal
  • Function : Author
Ayse Balat
  • Function : Author
Csaba Bereczki
  • Function : Author
Beata Bienias
  • Function : Author
Per Brandstrom
  • Function : Author
Francoise Broux
  • Function : Author
Silvia Consolo
  • Function : Author
Ivana Gojkovic
  • Function : Author
Jaap W. Groothoff
  • Function : Author
Kristine Hommel
  • Function : Author
Holger Hubmann
  • Function : Author
Fiona E. M. Braddon
  • Function : Author
Tatiana E. Pankratenko
  • Function : Author
Fotios Papachristou
  • Function : Author
Lucy A. Plumb
  • Function : Author
Ludmila Podracka
  • Function : Author
Sylwester Prokurat
  • Function : Author
Anna Bjerre
  • Function : Author
Carolina Cordinha
  • Function : Author
Juuso Tainio
  • Function : Author
Enkelejda Shkurti
  • Function : Author
Giuseppina Sparta
  • Function : Author
Karel Vondrak
  • Function : Author
Kitty J. Jager
  • Function : Author
Jun Oh
  • Function : Author
Marjolein Bonthuis
  • Function : Author

Abstract

BACKGROUND: Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. METHODS: We included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression. RESULTS: Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74] and a higher risk of death [aHR 1.79 (95% CI 1.38-2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21-2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84-1.65)]. CONCLUSIONS: Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.
Fichier principal
Vignette du fichier
BPH_CKJ_2023_Schild.pdf (1.63 Mo) Télécharger le fichier
Origin : Publisher files allowed on an open archive

Dates and versions

hal-04097668 , version 1 (15-05-2023)

Licence

Attribution - NonCommercial

Identifiers

Cite

Raphael Schild, Simeon Dupont, Jerome Harambat, Enrico Vidal, Ayse Balat, et al.. Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study. Clinical Kidney Journal, 2023, 16 (4), pp.745-755. ⟨10.1093/ckj/sfad008⟩. ⟨hal-04097668⟩

Collections

U1219
0 View
4 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More