Good News for Kids With Kidney Disease

End stage kidney disease in children requires dialysis but death risk has declined

(RxWiki News) For children with end stage kidney disease, dialysis may be necessary to survive. Over the past 20 years, improvements in dialysis have led to lower rates of death.

With chronic kidney disease (CKD), the kidneys have some permanent damage but they may still work well enough for a patient to live. CKD, however, can lead to end stage kidney (renal) disease (ESKD). At this stage of kidney failure, a patient needs dialysis or an organ transplant to survive.

A new study has found that death rates among children and adolescents undergoing ESKD treatment with dialysis have declined over the past two decades.

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Mark M. Mitsnefes, MD, of Cincinnati Children's Hospital Medical Center, and colleagues conducted a study to determine if all-cause, cardiovascular and infection-related death rates have changed between 1990 and 2010 among patients younger than 21 years of age with ESKD initially treated with dialysis.

Scientists identified a total of 23,401 children and adolescents who initiated ESKD treatment with dialysis during those two decades, and noted a significant decrease in mortality rates among these young patients over that time period.

When comparing children under the age of 5 who started dialysis in 1990-1994 to those starting in 2005-2010, Dr. Mitsnefes and his team observed a mortality drop from 112.2 per 1,000 person-years to 83.4 per 1,000 person-years. Among those aged 5 and older, the mortality rates declined from 44.6 per 1,000 person-years to 25.9 over the same time period.

One in 10 American adults—more than 20 million—have some level of chronic kidney disease (CKD). In the pediatric population (age 19 and under) the annual rate for CKD is only one or two new cases in every 100,000 children, according to the National Kidney and Urologic Diseases Information Clearinghouse.

Organ transplant remains the treatment of choice to maximize survival, growth and development among children, according to the study authors. While children with ESKD await transplant, dialysis is a life-saving therapy.

Dialysis filters the blood to get rid of harmful wastes in the body.

While mortality rates in children receiving maintenance dialysis are at least 30 times higher than the general pediatric population, the authors highlighted that “there have been substantial improvements in the care of children with ESKD between 1990 and 2010. Improved pre-dialysis care, advances in dialysis technology and greater experience of clinicians may each have played a role.”

The investigators noted that further research is needed to determine the specific factors responsible for this decrease in mortality rates.

The study was published in the May 8 issue of the Journal of the American Medical Association.

Review Date: 
May 8, 2013