Preka, Evgenia, Bonthuis, Marjolein, Harambat, Jerome ORCID: 0000-0003-2016-120X, Jager, Kitty J., Groothoff, Jaap W., Baiko, Sergey, Bayazit, Aysun K., Boehm, Michael, Cvetkovic, Mirjana, Edvardsson, Vidar O., Fomina, Svitlana, Heaf, James G., Holtta, Tuula, Kis, Eva, Kolvek, Gabriel, Koster-Kamphuis, Linda ORCID: 0000-0002-9971-995X, Molchanova, Elena A., Munoz, Marina, Neto, Gisela, Novljan, Gregor, Printza, Nikoleta, Sahpazova, Emilija, Sartz, Lisa, Sinha, Manish D., Vidal, Enrico, Vondrak, Karel, Vrillon, Isabelle, Weber, Lutz T., Weitz, Marcus, Zagozdzon, Ilona, Stefanidis, Constantinos J. and Bakkaloglu, Sevcan A. (2019). Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study. Nephrol. Dial. Transplant., 34 (11). S. 1932 - 1941. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2385

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Abstract

Background There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment. Methods We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR >= 8mL/min/1.73 m(2) (early starters) and eGFR >= 8mL/min/1.73 m(2) (late starters). The primary outcomes 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 The median eGFR at the start of dialysis was 6.1 for late versus 10.5mL/min/1.73 m(2) for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings. Conclusions We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Preka, EvgeniaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonthuis, MarjoleinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Harambat, JeromeUNSPECIFIEDorcid.org/0000-0003-2016-120XUNSPECIFIED
Jager, Kitty J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Groothoff, Jaap W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baiko, SergeyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bayazit, Aysun K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boehm, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cvetkovic, MirjanaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Edvardsson, Vidar O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fomina, SvitlanaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heaf, James G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Holtta, TuulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kis, EvaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kolvek, GabrielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koster-Kamphuis, LindaUNSPECIFIEDorcid.org/0000-0002-9971-995XUNSPECIFIED
Molchanova, Elena A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Munoz, MarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neto, GiselaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Novljan, GregorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Printza, NikoletaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sahpazova, EmilijaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sartz, LisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sinha, Manish D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vidal, EnricoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vondrak, KarelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vrillon, IsabelleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, Lutz T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weitz, MarcusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zagozdzon, IlonaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stefanidis, Constantinos J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bakkaloglu, Sevcan A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-129167
DOI: 10.1093/ndt/gfz069
Journal or Publication Title: Nephrol. Dial. Transplant.
Volume: 34
Number: 11
Page Range: S. 1932 - 1941
Date: 2019
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2385
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RENAL REPLACEMENT THERAPY; RELATIVE CONTRIBUTION; PRACTICE GUIDELINE; CHILDREN; MORTALITY; FAILURE; START; SURVIVAL; ADEQUACY; SOCIETYMultiple languages
Transplantation; Urology & NephrologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/12916

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