Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995-2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5. 27 yrs. (range: 1 month-24 yrs). Forty-five children (42 %) had dysplastic kidneys and 19 (17.5 %) had focal segmental glomerulosclerosis. Twenty-five (22.7 %) received peritoneal dialysis, 59 (53.6 %) hemodialysis, and 6 (23.6 %) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25-17.54 years). Mean follow-up was 13.5 ± 5. 84 yrs. Seventy-nine patients (71.8 %) underwent successful transplantation, 10 (11.2 %) had graft failure, and 8 (7.3 %) continued dialysis without transplantation. Twelve patients (10.9 %) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84 %: 90 % for patients older than 5 years and 61 % for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.