Outcomes of chronic dialysis in Korean children with respect to survival rates and causes of death

Abstract

Purpose: Adult Korean patients on chronic dialysis have a 10-year survival rate of 50%, with cardiovascular problems being the most significant cause of death. The 2011 annual report of the North American Pediatric Renal Trials and Collaborative Studies group reported 3-year survival rates of 93.4% and relatively poorer survival in younger patients. In this study, we have reviewed data from Korean Pediatric Chronic Kidney Disease Registry to assess survival rates and causes of death in Korean children on chronic dialysis.

Methods: We have analyzed the data from Korean Pediatric Chronic Kidney Disease Registry from 2002 to 2015. The study population was divided by age, sex and modality of dialysis. Survival rates were estimated at 1, 3, and 5 years from the initiation of dialysis. The most significant causative factor was designated as the cause of death.

Results: The overall estimated patient survival rates were 98%, 94%, and 90% at 1, 3, and 5 years, respectively. There was no significant difference in survival rates between males and females. Patients for whom dialysis was initiated before 2 years of age (n=51) had significantly lower survival rates than those for whom dialysis was initiated at and over 6 years of age (n=327). No significant difference was observed in survival rates between all the patients on peritoneal dialysis (PD) and those on hemodialysis (HD). However, the 5-year survival of children less than 2 years of age on PD was significantly lower than that of children at and over 6 years of age and that on HD was significantly lower than that of children at and over 12 years of age. In all, 36 patients had died

the mortality rate was 23.7 per 1,000 patient years. The most common causes of death were infections and cardiopulmonary diseases.

Conclusion: The outcomes observed in this study were better than those observed in adults and comparable to those observed in pediatric studies in other countries. To improve the outcomes of children on chronic dialysis, it is necessary to prevent dialysis-related complications such as infection, congestive heart failure, or CNS hemorrhage and best control treatable comorbidities.