End-stage Renal Disease and Long-term Survival Among Survivors of Extracorporeal Membrane Oxygenation

Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purposewas to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%)had some type of neurodevelopmental delay.Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

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Effectiveness of recombinant human erythropoietin, vitamin D3and iron therapy on long-term survival of patients with end-stage renal disease receiving haemodialysis: analysis of 702 patients after 10-year follow-up

Public Health Nutrition ◽

10.1017/s1368980009005308 ◽

2009 ◽

Vol 12 (12) ◽

pp. 2410-2415 ◽

Cited By ~ 3

Author(s):

Huan-Cheng Chang ◽

Chien-Lung Chen ◽

Te-Li Chiu ◽

Shu-I Chen ◽

Amy Ming-Fang Yen ◽

...

Keyword(s):

Vitamin D ◽

Survival Rate ◽

Renal Disease ◽

End Stage Renal Disease ◽

Recombinant Human Erythropoietin ◽

Term Survival ◽

Human Erythropoietin ◽

Stage Renal Disease ◽

End Stage

AbstractObjectiveFew studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).DesignA retrospective cohort study.SettingThe largest regional hospital renowned for haemodialysis in northern Taiwan.SubjectsA total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.ResultsThe rate of overall use of rhEPO, vitamin D3or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0·38, 95 % CI 0·30, 0·47,P< 0·0001). Similar findings were noted for patients receiving vitamin D3(HR = 0·36, 95 % CI 0·21, 0·64,P= 0.0004) and Fe (HR = 0·45, 95 % CI 0·33, 0·61,P< 0·0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0·30, 95 % CI 0·22, 0·42) or without (HR = 0·48, 95 % CI 0·38, 0·61) combined use of Fe or vitamin D3.ConclusionsWe demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.

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