Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study

Evgenia Preka; Marjolein Bonthuis; Jerome Harambat; Kitty J Jager; Jaap W Groothoff; Sergey Baiko; Aysun K Bayazit; Michael Boehm; Mirjana Cvetkovic; Vidar O Edvardsson; Svitlana Fomina; James G Heaf; Tuula Holtta; Eva Kis; Gabriel Kolvek; Linda Koster-Kamphuis; Elena A Molchanova; Marina Muňoz; Gisela Neto; Gregor Novljan; Nikoleta Printza; Emilija Sahpazova; Lisa Sartz; Manish D Sinha; Enrico Vidal; Karel Vondrak; Isabelle Vrillon; Lutz T Weber; Marcus Weitz; Ilona Zagozdzon; Constantinos J Stefanidis; Sevcan A Bakkaloglu

doi:10.1093/ndt/gfz069

Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study

Evgenia Preka
, Marjolein Bonthuis
, Jerome Harambat
, Kitty J Jager
, Jaap W Groothoff
, Sergey Baiko
, Aysun K Bayazit
, Michael Boehm
, Mirjana Cvetkovic
, Vidar O Edvardsson
, Svitlana Fomina
, James G Heaf
, Tuula Holtta
, Eva Kis
, Gabriel Kolvek
, Linda Koster-Kamphuis
, Elena A Molchanova
, Marina Muňoz
, Gisela Neto
, Gregor Novljan

Nikoleta Printza, Emilija Sahpazova, Lisa Sartz, Manish D Sinha, Enrico Vidal, Karel Vondrak, Isabelle Vrillon, Lutz T Weber, Marcus Weitz, Ilona Zagozdzon, Constantinos J Stefanidis, Sevcan A Bakkaloglu

Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus.
Department of Pediatric Nephrology, University Children's Hospital, Vienna, Austria.
Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
Children's Hospital, University of Helsinki, Helsinki, Finland.
Pediatric Department, Faculty of Medicine, Safarik University, Kosice, Slovakia.
University Pediatric Clinic, Skopje, FYR of Macedonia.
Department of Clinical Sciences, Pediatric Nephrology, Skåne University Hospital, Lund University, Lund, Sweden.

Research output: Contribution to journal › Article › Academic › peer-review

12 Downloads (Pure)

Abstract

BACKGROUND: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.

METHODS: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.

RESULTS: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.

CONCLUSIONS: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.

Original language	English
Pages (from-to)	1932-1940
Number of pages	9
Journal	Nephrology, dialysis, transplantation
Volume	34
Issue number	11
DOIs	https://doi.org/10.1093/ndt/gfz069
Publication status	Published - 1 Nov 2019

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1093/ndt/gfz069

Association-between-timing-of-dialysis-initiation-and-clinical-outcomes-in-the-paediatric-population.pdfFinal published version, 356 KBLicence: Taverne

Cite this

Preka, E., Bonthuis, M., Harambat, J., Jager, K. J., Groothoff, J. W., Baiko, S., Bayazit, A. K., Boehm, M., Cvetkovic, M., Edvardsson, V. O., Fomina, S., Heaf, J. G., Holtta, T., Kis, E., Kolvek, G., Koster-Kamphuis, L., Molchanova, E. A., Muňoz, M., Neto, G., ... Bakkaloglu, S. A. (2019). Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study. Nephrology, dialysis, transplantation, 34(11), 1932-1940. https://doi.org/10.1093/ndt/gfz069

@article{ccaa89ee3ebb499d94c107056e4d9577,

title = "Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study",

abstract = "BACKGROUND: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.METHODS: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.RESULTS: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.CONCLUSIONS: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.",

author = "Evgenia Preka and Marjolein Bonthuis and Jerome Harambat and Jager, \{Kitty J\} and Groothoff, \{Jaap W\} and Sergey Baiko and Bayazit, \{Aysun K\} and Michael Boehm and Mirjana Cvetkovic and Edvardsson, \{Vidar O\} and Svitlana Fomina and Heaf, \{James G\} and Tuula Holtta and Eva Kis and Gabriel Kolvek and Linda Koster-Kamphuis and Molchanova, \{Elena A\} and Marina Mu{\v n}oz and Gisela Neto and Gregor Novljan and Nikoleta Printza and Emilija Sahpazova and Lisa Sartz and Sinha, \{Manish D\} and Enrico Vidal and Karel Vondrak and Isabelle Vrillon and Weber, \{Lutz T\} and Marcus Weitz and Ilona Zagozdzon and Stefanidis, \{Constantinos J\} and Bakkaloglu, \{Sevcan A\}",

year = "2019",

month = nov,

day = "1",

doi = "10.1093/ndt/gfz069",

language = "English",

volume = "34",

pages = "1932--1940",

journal = "Nephrology, dialysis, transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "11",

}

Preka, E , Bonthuis, M, Harambat, J, Jager, KJ , Groothoff, JW, Baiko, S, Bayazit, AK, Boehm, M, Cvetkovic, M, Edvardsson, VO, Fomina, S, Heaf, JG, Holtta, T, Kis, E, Kolvek, G, Koster-Kamphuis, L, Molchanova, EA, Muňoz, M, Neto, G, Novljan, G, Printza, N, Sahpazova, E, Sartz, L, Sinha, MD, Vidal, E, Vondrak, K, Vrillon, I, Weber, LT, Weitz, M, Zagozdzon, I, Stefanidis, CJ & Bakkaloglu, SA 2019, 'Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study', Nephrology, dialysis, transplantation, vol. 34, no. 11, pp. 1932-1940. https://doi.org/10.1093/ndt/gfz069

TY - JOUR

T1 - Association between timing of dialysis initiation and clinical outcomes in the paediatric population

T2 - an ESPN/ERA-EDTA registry study

AU - Preka, Evgenia

AU - Bonthuis, Marjolein

AU - Harambat, Jerome

AU - Jager, Kitty J

AU - Groothoff, Jaap W

AU - Baiko, Sergey

AU - Bayazit, Aysun K

AU - Boehm, Michael

AU - Cvetkovic, Mirjana

AU - Edvardsson, Vidar O

AU - Fomina, Svitlana

AU - Heaf, James G

AU - Holtta, Tuula

AU - Kis, Eva

AU - Kolvek, Gabriel

AU - Koster-Kamphuis, Linda

AU - Molchanova, Elena A

AU - Muňoz, Marina

AU - Neto, Gisela

AU - Novljan, Gregor

AU - Printza, Nikoleta

AU - Sahpazova, Emilija

AU - Sartz, Lisa

AU - Sinha, Manish D

AU - Vidal, Enrico

AU - Vondrak, Karel

AU - Vrillon, Isabelle

AU - Weber, Lutz T

AU - Weitz, Marcus

AU - Zagozdzon, Ilona

AU - Stefanidis, Constantinos J

AU - Bakkaloglu, Sevcan A

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.METHODS: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.RESULTS: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.CONCLUSIONS: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.

AB - BACKGROUND: There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.METHODS: We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.RESULTS: The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.CONCLUSIONS: We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.

U2 - 10.1093/ndt/gfz069

DO - 10.1093/ndt/gfz069

M3 - Article

SN - 0931-0509

VL - 34

SP - 1932

EP - 1940

JO - Nephrology, dialysis, transplantation

JF - Nephrology, dialysis, transplantation

IS - 11

ER -

Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study

Abstract

UN SDGs

Access to Document

Fingerprint

Cite this