Timing and Modality of Kidney Replacement Therapy in Children and Adolescents

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dc.contributor.authorThumfart J.
dc.contributor.authorWagner S.
dc.contributor.authorKirchner M.
dc.contributor.authorAzukaitis K.
dc.contributor.authorBayazit A.K.
dc.contributor.authorObrycki L.
dc.contributor.authorCanpolat N.
dc.date.accessioned2024-08-31T07:42:27Z
dc.date.available2024-08-31T07:42:27Z
dc.date.issued2024
dc.departmentEge Üniversitesien_US
dc.description.abstractIntroduction: The choice and timing of kidney replacement therapy (KRT) is influenced by clinical factors, laboratory features, feasibility issues, family preferences, and clinicians' attitudes. We analyzed the factors associated with KRT modality and timing in a multicenter, multinational prospective pediatric cohort study. Methods: A total of 695 pediatric patients with chronic kidney disease (CKD) enrolled into the Cardiovascular Comorbidity in Children with CKD (4C) study at age 6 to 17 years with estimated glomerular filtration rate (eGFR) of 10 to 60 ml/min per 1.73 m2 were investigated. Competing risk regression was performed to identify factors associated with initiation of dialysis or preemptive transplantation (Tx), including primary renal diagnosis, demographics, anthropometrics, and laboratory parameters. Results: During the 8-year observation period, 342 patients (49%) started KRT. Of these, 200 patients started dialysis, whereas 142 patients underwent preemptive Tx. A lower eGFR at enrolment (Hazard ratio [HR]: 0.76 [95% confidence interval: 0.74–0.78]), a steeper eGFR slope (HR: 0.90 [0.85–0.95], and a higher systolic blood pressure SD score (SDS) (HR: 2.07 [1.49–2.87]) increased the likelihood of KRT initiation. Patients with glomerulopathies were more likely to start dialysis than children with congenital anomalies of the kidneys and urinary tracts (CAKUT) (HR: 3.81 [2.52–5.76]). Lower body mass index (BMI) SDS (HR: 0.73 [0.6–0.89]) and lower hemoglobin (HR: 0.8 [0.72–0.9]) were associated with higher likelihood of dialysis. A significant center effect was observed, accounting for 6.8% (dialysis) to 8.7% (preemptive Tx) of explained variation. Conclusion: The timing and choice of KRT in pediatric patients is influenced by the rate of kidney function loss, the underlying kidney disease, nutritional status, blood pressure, anemia and center-specific factors. © 2024en_US
dc.description.sponsorshipKFH Foundation for Preventive Medicine; ERKNet; European Rare Kidney Disease Reference Network; KfH Foundation for Preventive Medicine; ERA-EDTA; Bundesministerium für Bildung und Forschung, BMBF, (01EO0802); Bundesministerium für Bildung und Forschung, BMBF; European Commission, EC, (ROTRF 365520785, 101085068); European Commission, EC; Roche Organ Transplant Research Foundation, ROTRF, (ROTRF 365520785); Roche Organ Transplant Research Foundation, ROTRFen_US
dc.identifier.doi10.1016/j.ekir.2024.06.009
dc.identifier.issn2468-0249
dc.identifier.scopus2-s2.0-85197031287en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org10.1016/j.ekir.2024.06.009
dc.identifier.urihttps://hdl.handle.net/11454/103880
dc.indekslendigikaynakScopusen_US
dc.language.isoenen_US
dc.publisherElsevier Inc.en_US
dc.relation.ispartofKidney International Reportsen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmz20240831_Uen_US
dc.subjectdialysis initiationen_US
dc.subjectpediatric risk factorsen_US
dc.subjectprogression kidney diseaseen_US
dc.titleTiming and Modality of Kidney Replacement Therapy in Children and Adolescentsen_US
dc.typeArticleen_US

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