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Clinical characteristics at the renal replacement therapy initiation of Japanese pediatric patients: a nationwide cross-sectional study

  • Daishi HiranoEmail author
  • Eisuke Inoue
  • Mayumi Sako
  • Akira Ashida
  • Masataka Honda
  • Shori Takahashi
  • Kazumoto Iijima
  • Motoshi Hattori
  • the Japanese Society of Pediatric Nephrology
Original article
  • 70 Downloads

Abstract

Background

Although there is debate regarding the timing of initiation of renal replacement therapy (RRT) in adults with end-stage renal disease, there is a paucity of reliable epidemiological data on pediatric patients. The present study was performed to investigate current practice in Japan with regard to the timing of initiation of RRT in children based on estimated glomerular filtration rate (eGFR).

Methods

A total of 649 pediatric patients < 20 years old with eGFR at the initiation of RRT between 1 January 2006 and 31 December 2013 were included in the study. Baseline eGFR was calculated for each patient using the Schwartz formula.

Results

eGFR at the start of RRT was 12.1 mL/min/1.73 m2 [interquartile range (IQR) 8.4–16.3]. A total of 209 children (32.2%) had high eGFR (eGFR > 15 mL/min/1.73 m2) at the initiation of RRT. Initiation of RRT was more likely in those undergoing preemptive transplantation (PEKT) with high eGFR [odds ratio (OR) 4.16; 95% confidence interval (CI) 1.95–8.90, P < 0.001]. There were 31 deaths of various causes during follow-up, with infections representing the leading causes of death.

Conclusions

The median eGFR at the initiation of RRT in children showed a wide range of variation. Further studies are needed to investigate the impact of the decision regarding when to initiate RRT in individual pediatric patients.

Keywords

Renal replacement therapy Children eGFR Initiation Timing Dialysis 

Notes

Acknowledgements

This work was funded by the Japanese Society for Pediatric Nephrology (JSPN). The authors thank all patients, families, physicians, and institutes who contributed to the JSPN ESRD Survey. The authors also thank Drs. Akira Matsunaga, Toru Igarashi, Toshiyuki Ota, Takao Konomoto, Naoko Ito, Ryoko Harada, Takuya Fujimaru, and Kenichi Satomura as members of the JSPN ESRD Survey Committee, and Drs. Yuko Akioka, Kenji Ishikura, Yuko Hamasaki, Yoshitomo Itami, Yoshimitsu Goto, Yoshihiko Ueda, Misako Hiramatsu, Shuich Ito, Osamu Uemura, Satoshi Sasaki, Ken Hatae, Hiroshi Hataya, Mikiya Fujieda, and Hiroshi Yoshimura and the members of the JSPN, the Japanese Society for Dialysis Therapy (JSDT), and the Japanese Society for Clinical Renal Transplantation (JSCRT) for their contributions to data collection. The authors also thank Prof. Yasuo Ohashi, Mr. Tetsuji Kaneko, Mr. Masaaki Kurihara, Ms. Chie Matsuda, and Ms. Takako Arai for their help with data management [Japan Clinical Research Support Unit (Tokyo), and Ever Progressing Clinical Research Support Unit (Tokyo, Japan)].

Author contributions

DH and MH designed the study; DH and EI carried out statistical analyses; DH, MS, AA, EI, MH, ST, and MH analyzed the data; DH and MH made the figures; DH, MS, AA, EI, MH, ST, and MH drafted and revised the paper; all authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Daishi Hirano
    • 1
    Email author
  • Eisuke Inoue
    • 2
  • Mayumi Sako
    • 3
  • Akira Ashida
    • 4
  • Masataka Honda
    • 5
  • Shori Takahashi
    • 6
  • Kazumoto Iijima
    • 7
  • Motoshi Hattori
    • 8
  • the Japanese Society of Pediatric Nephrology
  1. 1.Department of PediatricsThe Jikei University School of MedicineTokyoJapan
  2. 2.Medical InformaticsSt. Marianna University School of MedicineKawasakiJapan
  3. 3.Division for Clinical Trials, Department of Clinical Research Promotion, Clinical Research CenterNational Center for Child Health and DevelopmentTokyoJapan
  4. 4.Department of PediatricsOsaka Medical CollegeOsakaJapan
  5. 5.Department of NephrologyTokyo Metropolitan Children’s Medical CenterTokyoJapan
  6. 6.Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
  7. 7.Department of PediatricsKobe University Graduate School of MedicineKobeJapan
  8. 8.Department of Pediatric Nephrology, School of MedicineTokyo Women’s Medical UniversityTokyoJapan

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