Clinical characteristics at the renal replacement therapy initiation of Japanese pediatric patients: a nationwide cross-sectional study
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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).
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.
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.
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.
KeywordsRenal replacement therapy Children eGFR Initiation Timing Dialysis
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)].
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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